Medicare Stars & HEDIS Quality Director

Blue Shield of California; California; Hybrid; USD 160,000 - 240,000; Full time

Job summary

Blue Shield of California is seeking a Director of Clinical Quality to lead Medicare Stars and HEDIS strategy, execution, and performance oversight. You will drive care-gap closure, quality improvement initiatives, and member experience enhancements in a collaborative, results-driven environment.

The role requires extensive experience in Stars/HEDIS, CMS regulations, and leading large, cross-functional teams, with a hybrid in-office model two days per week in California.

Qualifications

• Bachelor’s degree or higher with relevant healthcare program experience.
• 10 years leading large, cross-functional quality improvement programs.
• 6 years people management and supervising teams.
• 6 years driving Stars/HEDIS performance initiatives.
• Strong data interpretation and analytics-driven strategy.

Responsibilities

• Lead enterprise Medicare Stars HEDIS improvement strategy aligned with quality roadmap.
• Develop interventions addressing care gaps to improve Stars/HEDIS performance.
• Oversee end-to-end operations across clinical, data, and outreach teams.
• Collaborate with providers, vendors, and regulators to advance quality initiatives.
• Maintain dashboards to monitor Stars/HEDIS metrics and accountability.
• Lead test-and-learn initiatives to optimize strategies.
• Improve Medicare member experience through quality interventions.
• Manage vendor relationships, budgets, and project management.
• Lead a team fostering learning, innovation, and accountability.
• Serve as SME for CMS requirements and industry best practices.

Skills

Leadership

HEDIS/Stars

Healthcare analytics

CMS/MA quality programs

Stakeholder engagement

Education

Master’s in Public Health

Bachelor’s degree or equivalent

Job description

Blue Shield of California is seeking a Director of Clinical Quality to lead Medicare Stars and HEDIS strategy, execution, and performance oversight. You will drive care-gap closure, quality improvement initiatives, and member experience enhancements in a collaborative, results-driven environment.

The role requires extensive experience in Stars/HEDIS, CMS regulations, and leading large, cross-functional teams, with a hybrid in-office model two days per week in California.