Director of Medicare Stars & HEDIS Quality Improvement

Blue Shield of CA; Long Beach (CA); Hybrid; USD 180,000 - 260,000; Full time

Job summary

Blue Shield of CA seeks a Director of Clinical Quality - Medicare Stars to lead the organization’s HEDIS strategy and performance oversight, driving gap closure, quality improvement, health outcomes, and member experience for Medicare programs.

The Director will shape the clinical quality roadmap, manage cross-functional teams, and ensure delivery under Stars and HEDIS expectations while collaborating with executives, providers, and operations to sustain top-tier rankings.

Qualifications

• Bachelor's degree or higher with additional relevant experience.
• Master's in Public Health (MPH), Healthcare Administration (MHA), or related field preferred.
• 10 years of healthcare experience leading large-scale cross-functional quality programs.
• 6 years of people management experience supervising direct reports.
• 6 years of direct Stars and HEDIS performance experience.

Responsibilities

• Lead Medicare Stars HEDIS strategy, execution, and performance oversight.
• Oversee clinical quality roadmap, operations, and contract performance across multiple Medicare contracts.
• Drive clinical gap closure, health outcomes improvement, and member experience initiatives.
• Collaborate with clinical, operational, and executive teams to enable systemic quality improvements.
• Guide teams through compliance with CMS requirements and industry best practices.

Skills

Healthcare analytics

HEDIS

Quality improvement

Stakeholder engagement

Project management

Leadership

Education

Bachelor's degree

Master's degree preferred

Job description

Blue Shield of CA seeks a Director of Clinical Quality - Medicare Stars to lead the organization’s HEDIS strategy and performance oversight, driving gap closure, quality improvement, health outcomes, and member experience for Medicare programs.

The Director will shape the clinical quality roadmap, manage cross-functional teams, and ensure delivery under Stars and HEDIS expectations while collaborating with executives, providers, and operations to sustain top-tier rankings.