Medasource
Apply Now
Position: MA Stars Director
Duration: 6 month CTH
Location: Remote (25% Travel)
Position Summary:
The Director of Quality for MA Stars will lead strategic initiatives to achieve and sustain exceptional Medicare Advantage Star Ratings performance across the health plan. This role is responsible for developing and executing quality improvement programs, collaborating with cross-functional teams, leading vendor partnerships, member satisfaction, and ensuring compliance with CMS and regulatory requirements. The ideal candidate will bring deep expertise in MA Stars, HEDIS, CAHPS, and HOS metrics, and a proven track record of driving measurable improvements in quality outcomes.
Key Responsibilities:
-Strategic Leadership: Develop and execute strategies to meet and exceed Medicare Stars performance targets to achieve and maintain 4+ star ratings. Drive improvement in clinical quality metrics, with a focus on Rx adherence measures (statin use, hypertension medication adherence, etc.). Monitor regulatory updates and ensure compliance with CMS Star Ratings requirements.
-Clinical Metrics Management: Analyze performance data and trends for clinical metrics to identify improvement opportunities. Collaborate with clinical teams to develop and implement interventions to enhance outcomes. Lead efforts to optimize medication adherence programs and support pharmacy-related initiatives. Oversee performance tracking and analytics for HEDIS, CAHPS, HOS, and Part D measures.
-Monitor CMS updates and ensure compliance with regulatory requirements.
-Develop dashboards and reporting tools to communicate performance trends to executive leadership.
-Represent the organization in external quality forums and CMS-related engagements.
-Operational Excellence: Oversee daily operations related to quality initiatives, ensuring seamless execution and alignment with organizational goals. Develop processes to streamline workflows, enhance efficiency, and achieve measurable results. Foster a culture of continuous improvement and accountability across teams.
-Vendor Oversight: Manage relationships with external vendors, ensuring contractual obligations and quality deliverables are met. Evaluate vendor performance through established metrics and implement corrective actions when necessary. Serve as the primary liaison between vendors and internal stakeholders, promoting collaboration and alignment.
-Cross-Functional Collaboration: Partner with member experience, healthcare services, pharmacy, and IT teams to design and execute initiatives. Communicate performance outcomes and improvement plans to executive leadership and stakeholders. Lead or participate in workgroups to address system-wide challenges affecting Stars performance.
-Stakeholder Influence & Executive Engagement: Serve as a trusted advisor and thought leader to senior executives. Identify organizational gaps in resources, infrastructure, or capabilities that impact Stars performance. Build business cases for new or enhanced programs and interventions, supported by data-driven justification.
-Effectively educate and engage leadership on the short- and long-term implications of Stars performance, especially related to anticipated regulatory changes, industry trends, and the financial impact on quality bonus payments and member experience. Influence enterprise-level prioritization of initiatives critical to Stars success.
-Project Management: Drive execution of key Stars initiatives by applying structured project management methodologies, managing timelines, resources, and stakeholder engagement to ensure timely and effective delivery.
Qualifications:
-Bachelor’s degree in healthcare administration, public health, nursing, or related field (Master’s preferred).
-Minimum of 7 years of experience in healthcare quality, with at least 3 years focused on Medicare Advantage Stars.
-Strong knowledge of CMS Stars methodology, HEDIS, CAHPS, and HOS.
-Experience with data analytics tools and platforms (e.g., Excel, EPIC, Press Ganey).
-Excellent leadership, communication, and project management skills.
-Strong analytical skills, with ability to interpret and apply complex data sets.
-Excellent organizational, communication, and influence skills.
Preferred Skills:
-Master’s degree (MPH, MHA, MBA, or equivalent).
-Lean Six Sigma, PMP, or similar project, process improvement certifications.
-RN or clinical background.
-Experience working with health plans or managed care organizations.
-Familiarity with Medicare Advantage benefits and member experience strategies.
Medasource is an equal opportunity employer that does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, lactation and related medical conditions), gender identity or gender expression, sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances.
Benefits & Perks:
Medasource offers competitive medical, dental, vision, Health Savings Account, Dependent Care FSA, and supplemental coverage with plans that can fit each employee’s needs. We offer a 401k plan that includes a company match and is fully vested after you become eligible, paid time off, sick time, and paid company holidays. We also offer an Employee Assistance Program (EAP) that provides services like virtual counseling, financial services, legal services, life coaching, etc.
Pay Disclaimer:
The pay range for this job level is a general guideline only and not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law.
JO-2508-174309