Director, HEDIS & Quality Performance — Lead Medicare Stars

Capital Blue Cross; United States; Remote; USD 180,000 - 260,000; Full time

Job summary

Capital Blue Cross in the United States is seeking a Director, HEDIS & Quality Performance to lead the enterprise strategy to drive HEDIS performance across lines of business, with emphasis on Star Ratings. You will translate CMS/NCQA requirements into actionable plans and collaborate across functions to improve quality and member outcomes.

The role oversees a large team, builds internal HEDIS capability, and drives digital quality measurement while ensuring governance and accountability.

Qualifications

• Ability to lead complex, cross-functional initiatives in a matrixed organization.
• Strong analytical skills with a focus on financial implications of quality performance.
• Excellent executive communication, presentation, and influencing abilities.

Responsibilities

• Develop and own the multi-year enterprise HEDIS strategy with clear targets and owners.
• Translate CMS/NCQA requirements and market trends into actionable priorities.
• Oversee the full HEDIS lifecycle from data acquisition to digital quality measurement.
• Monitor performance across measures, markets, products to identify gaps and opportunities.
• Lead cross-functional governance for HEDIS results across functions and vendors.
• Develop talent and sustainable processes to reduce reliance on individual staff.
• Provide strategic forecasts and executive-level insights on results, risks and actions.

Skills

Cross-functional leadership

Analytical & financial acumen

Executive communication & influencing

Education

Master’s degree in healthcare administration or related field

Job description

Capital Blue Cross in the United States is seeking a Director, HEDIS & Quality Performance to lead the enterprise strategy to drive HEDIS performance across lines of business, with emphasis on Star Ratings. You will translate CMS/NCQA requirements into actionable plans and collaborate across functions to improve quality and member outcomes.

The role oversees a large team, builds internal HEDIS capability, and drives digital quality measurement while ensuring governance and accountability.