Director, Health Plan Quality — STAR & RAF Strategy

Community Hospital of the Monterey Peninsula; United States; Sur place; USD 180 000 - 280 000; Plein temps

Résumé du poste

Montage Health is seeking a Director of Health Plan Quality to lead enterprise performance across STAR, CAHPS, RAF, and related programs. You will collaborate with finance, analytics, and clinical teams to optimize quality, member outcomes, and financial performance for Medicare Advantage and Commercial plans.

The role requires deep expertise in CMS methodologies, population health, and value-based care, with a proven track record in senior healthcare leadership and regulatory alignment.

Qualifications

• Expertise in CMS STAR methodology, CAHPS, RAF/HCC models.
• Strong understanding of member experience drivers and complaint resolution processes.
• Proven ability to drive enterprise performance improvement.
• Strong background in value-based care and population health.
• Excellent leadership and stakeholder management skills.
• Data-driven decision-making expertise.

Responsabilités

• Lead enterprise STAR strategy to achieve and sustain 4+ STAR ratings.
• Oversee HEDIS, HOS, and administrative measure performance.
• Drive cross-functional initiatives to close care gaps and improve clinical outcomes.
• Align pharmacy, care management, population health, and network strategies to maximize STAR performance.
• Build relationships across health systems and local providers to maximize participation and engagement.

Connaissances

STAR methodology

CAHPS

RAF/HCC models

Stakeholder management

Data-driven decisions

Leadership

Formation

Bachelor's degree

Master's degree

Description du poste

Montage Health is seeking a Director of Health Plan Quality to lead enterprise performance across STAR, CAHPS, RAF, and related programs. You will collaborate with finance, analytics, and clinical teams to optimize quality, member outcomes, and financial performance for Medicare Advantage and Commercial plans.

The role requires deep expertise in CMS methodologies, population health, and value-based care, with a proven track record in senior healthcare leadership and regulatory alignment.