Director, Medicare Stars & HEDIS Quality

Blue Shield of CA; San Diego (CA); Hybrid; USD 180,000 - 280,000; Full time

Job summary

Blue Shield of California is seeking a Director of Clinical Quality - Medicare Stars to lead the organization’s HEDIS strategy, execution, and performance oversight, driving gap closure, quality improvement, health outcomes, and member experience. The Director will oversee the clinical quality roadmap, operational excellence, and performance across current and future Medicare contracts.

A proven leader in Stars, HEDIS, and quality improvement is required, with ability to collaborate across

Qualifications

• Bachelor's degree or higher; 4 years of additional relevant experience in lieu of a degree.
• MPH or MHA preferred.
• 10 years of healthcare experience leading large-scale, cross-functional quality programs.
• 6 years of people management with direct supervision.
• 6 years of direct Stars and HEDIS performance management experience.
• Strong ability to interpret complex healthcare data and apply analytics-driven strategies.
• Experience with Medicare Advantage quality programs and CMS requirements.
• Excellent communication with executive leadership, providers, and stakeholders.
• Solid project management skills to navigate deadlines and priorities.

Responsibilities

• Lead Medicare Stars HEDIS strategy, execution, and performance oversight.
• Drive clinical gap closure, quality improvement initiatives, health outcomes and member experience.
• Oversee the clinical quality strategic roadmap and operational excellence.
• Collaborate across clinical and operational functions to drive systemic change.
• Manage multi-contract performance across Stars and HEDIS.

Skills

Cross-functional program leadership

Data analytics & interpretation

Quality improvement methodologies

Medicare Advantage & CMS requirements

Executive communication

Project management

Education

Master's in Public Health (MPH) or Healthcare Administration (MHA)

Bachelor's degree or High School Diploma/GED + 4 years relevant experience

Job description

Blue Shield of California is seeking a Director of Clinical Quality - Medicare Stars to lead the organization’s HEDIS strategy, execution, and performance oversight, driving gap closure, quality improvement, health outcomes, and member experience. The Director will oversee the clinical quality roadmap, operational excellence, and performance across current and future Medicare contracts.

A proven leader in Stars, HEDIS, and quality improvement is required, with ability to collaborate across