Director, HEDIS and Quality Performance (Fully Remote)

Capital Blue Cross; United States; Remote; USD 140,000 - 210,000; Full time

Job summary

Capital Blue Cross is seeking a senior leader to develop and execute the multi-year enterprise HEDIS strategy, with Medicare Advantage Star Ratings targets. You will oversee the HEDIS lifecycle from data acquisition through validation and audit readiness, driving improvements and performance across measures.

We value collaboration across functions and data interoperability expertise (FHIR), CMS/NCQA knowledge, and a track record of delivering measurable Star Ratings gains in a health plan

Qualifications

• Minimum 7 years leading HEDIS strategy and improvement with measurable results.
• Expertise in ECDS reporting, data interoperability (FHIR), and CMS/NCQA requirements.
• Ability to lead complex cross-functional initiatives in a matrixed org with strong analytics.

Responsibilities

• Develop and lead the multi-year enterprise HEDIS strategy with clear targets and routines.
• Oversee the full HEDIS lifecycle: data acquisition, chart retrieval, validation, and audit readiness.
• Monitor performance across measures, providers, and products; identify gaps and drive action.

Skills

HEDIS leadership

Star Ratings

ECDS reporting

FHIR interoperability

CMS/NCQA requirements

Cross-functional leadership

Job description

• Develop and lead the multi-year enterprise HEDIS strategy, including Medicare Advantage Star Ratings measures, with clear targets and performance routines.
• Oversee the full HEDIS lifecycle, including data acquisition, chart retrieval, validation, audit readiness, and digital quality measurement.
• Monitor performance across measures, providers, and products; identify gaps and drive corrective action.

Qualifications:

• Minimum 7 years leading HEDIS strategy and improvement in a health plan, with measurable results on Star Ratings.
• Demonstrated expertise in ECDS reporting, clinical data interoperability (FHIR), and CMS/NCQA requirements.
• Proven ability to lead complex cross-functional initiatives in a matrixed organization with strong analytical and communication skills.

About Us:

• Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association, committed to improving member and community health.
• We foster a flexible environment where wellbeing is prioritized and offer generous benefits and professional growth opportunities.

Capital Blue Cross

Capital Blue Cross is a health insurance company and independent licensee of the Blue Cross Blue Shield Association, focused on improving the health and well-being of its members and communities. The company fosters a flexible, caring culture and is consistently voted one of the "Best Places to Work in PA."