Quality Improvement Leader - Health Plan STARS & HEDIS

Astiva Health, Inc; California; Vor Ort; USD 120.000 - 160.000; Vollzeit

Zusammenfassung

Astiva Health, Inc. in Orange, CA seeks a Manager of Quality Improvement to lead Quality Management, Quality Improvement (QI), and STARS initiatives.

You will partner with senior leadership to advance performance across HEDIS, RAF, and related measures while ensuring regulatory compliance and efficient operations. This role requires a strategic thinker with deep managed care experience, strong data analysis skills, and proven ability to recruit and develop talent.

Qualifikationen

• 7+ years senior-level managed care operations experience.
• Master’s in Public Health, Health Science, or RN/NP/BSN licensure.
• 5+ years QI experience at the plan level preferred.
• Experience with HMO, Medi-Cal/Medicaid, Medicare, insurance, or relevant government/public service preferred.
• Must be able to travel for work up to 5% of the time.
• Board reporting and strategic planning experience preferred.
• Experience overseeing delegated medical groups, IPAs, and contracted healthcare entities.

Aufgaben

• Develop strategy, deploy systems, refine workflows for Quality Management, Quality Improvement (QI), and Quality Assurance.
• Maintain compliance with operating procedures and reporting standards to meet state/federal requirements.
• Collaborate with senior management to shape STARS improvement aligned with Astiva’s planning.
• Formulate strategies to enhance HEDIS, CAHPS, HOS, and STARS-related measures.
• Design and oversee monitoring/reporting to align deliverables with budgets.
• Annually review and update the QI program and Medicare policies.
• Develop quarterly reports on QI activity progress and performance.

Kenntnisse

Quality Improvement

Quality Management

Leadership

Data Analysis

Healthcare Compliance

Communication

Ausbildung

Master's in Public Health

RN/NP/BSN licensure

Tools

HEDIS

STARS

RAF

HCC

Jobbeschreibung

Astiva Health, Inc. in Orange, CA seeks a Manager of Quality Improvement to lead Quality Management, Quality Improvement (QI), and STARS initiatives.

You will partner with senior leadership to advance performance across HEDIS, RAF, and related measures while ensuring regulatory compliance and efficient operations. This role requires a strategic thinker with deep managed care experience, strong data analysis skills, and proven ability to recruit and develop talent.