Director, HEDIS & Quality – Star-Ratings Strategy

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

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