Director, Clinical Quality (Medicare Stars)

Blue Shield of California; California; Hybrid; USD 160,000 - 240,000; Full time

Job summary

Blue Shield of California is seeking a Director of Clinical Quality to lead Medicare Stars and HEDIS strategy, execution, and performance oversight. You will drive care-gap closure, quality improvement initiatives, and member experience enhancements in a collaborative, results-driven environment.

The role requires extensive experience in Stars/HEDIS, CMS regulations, and leading large, cross-functional teams, with a hybrid in-office model two days per week in California.

Qualifications

• Bachelor’s degree or higher with relevant healthcare program experience.
• 10 years leading large, cross-functional quality improvement programs.
• 6 years people management and supervising teams.
• 6 years driving Stars/HEDIS performance initiatives.
• Strong data interpretation and analytics-driven strategy.

Responsibilities

• Lead enterprise Medicare Stars HEDIS improvement strategy aligned with quality roadmap.
• Develop interventions addressing care gaps to improve Stars/HEDIS performance.
• Oversee end-to-end operations across clinical, data, and outreach teams.
• Collaborate with providers, vendors, and regulators to advance quality initiatives.
• Maintain dashboards to monitor Stars/HEDIS metrics and accountability.
• Lead test-and-learn initiatives to optimize strategies.
• Improve Medicare member experience through quality interventions.
• Manage vendor relationships, budgets, and project management.
• Lead a team fostering learning, innovation, and accountability.
• Serve as SME for CMS requirements and industry best practices.

Skills

Leadership

HEDIS/Stars

Healthcare analytics

CMS/MA quality programs

Stakeholder engagement

Education

Master’s in Public Health

Bachelor’s degree or equivalent

Job description

Job Description

The Director of Clinical Quality - Medicare Stars reports to the Senior Director of Clinical Quality and leads the organization’s Medicare Stars HEDIS strategy, execution, and performance oversight. This role is critical to maintaining and improving Medicare Star Ratings and HEDIS performance by driving initiatives focused on clinical gap closure, quality improvement, health outcomes, and member experience.

Your Role

The Director will oversee the clinical quality strategic roadmap, operational excellence, and performance oversight of multiple H-Contracts and future Medicare Advantage contracts. The position requires a dynamic leader with deep expertise in Stars, HEDIS, and quality improvement methodologies, as well as the ability to collaborate across clinical and operational functions to enhance performance outcomes and drive systemic change.

Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.

Responsibilities

• Lead the enterprise-wide Medicare Stars HEDIS improvement strategy, ensuring alignment with the Quality Roadmap and company goals to achieve optimal performance outcomes.
• Develop and implement targeted interventions that address gaps in care and drive measurable Stars and HEDIS improvements across populations.
• Oversee end-to-end operational processes, ensuring that clinical, data, and outreach teams are fully equipped to execute HEDIS Stars initiatives effectively.
• Work across internal teams and external partners, including providers, vendors, and regulatory agencies, to streamline quality initiatives and advance healthcare equity efforts.
• and maintain robust reporting dashboards to monitor HEDIS Stars metrics, identify improvement opportunities, and enhance organizational accountability.
• Lead test-and-learn initiatives to assess new strategies, leveraging insights from analytics to optimize Stars performance outcomes.
• Design and implement strategies that improve the Medicare member experience, fostering higher engagement and satisfaction through quality healthcare interventions.
• Oversee Stars and HEDIS vendor relationships, operational budgets, and project/program management to drive efficient operations and maximize impact.
• Lead a team of high-performing professionals, fostering a culture of continuous learning, innovation, and accountability in Stars and HEDIS operations.
• Serve as an SME for Medicare Stars Ratings, HEDIS measures, and quality performance—ensuring compliance with CMS regulations while keeping Blue Shield at the forefront of industry best practices.

Qualifications

• Bachelor’s degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree
• Master’s in Public Health (MPH), Healthcare Administration (MHA), or related field is preferred.
• 10 years of healthcare experience leading large-scale, cross-functional programs focused on quality improvement.
• 6 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports
• 6 years of direct experience managing Stars and HEDIS performance initiatives with proven success in driving improvements.
• Strong ability to interpret complex healthcare data, develop insights, and apply analytics-driven strategies.
• Experience in Medicare Advantage quality programs, CMS requirements, and industry-leading Stars & HEDIS performance improvement techniques.
• Exceptional communication skills, with the ability to engage executive leadership, providers, and stakeholders effectively.
• Strong project management skills, with the ability to navigate tight deadlines, manage competing priorities, and lead strategic initiatives successfully.

Hybrid

This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.

Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.

About Us

About Blue Shield of California

As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.

At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.

To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.

Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities – join us!

Our Values

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.

Physical Requirements

Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.

Please click here for further physical requirement detail.

Equal Employment Opportunity

External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity or disability status and any other classification protected by Federal, State and local laws.

JOB INFO

Job Category : Healthcare Services and Operations

Job Schedule : Full time

Locations :

Long Beach, CA, United States

CA, United States

El Dorado Hills, CA, United States

Lodi, CA, United States

Oakland, CA, United States

Rancho Cordova, CA, United States

San Diego, CA, United States

Woodland Hills, CA, United States

Pay Range for California : $160160.00 to $240460.00

Pay Range for Bay Area : $180544.00 to $271064.00

Note : Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate experience, location (California, Bay Area, or outside California), and current employee salaries for similar roles.

Role can be filled by a candidate requiring sponsorship : No