Quality Improvement Leader, Health Plan Strategy & STARS

Astiva Health; Orange (CA); On-site; USD 120,000 - 165,000; Full time

Job summary

Astiva Health, Inc. in Orange, CA, seeks a Manager of Quality Improvement to oversee Quality Management, Quality Improvement, Risk Adjustment Factors, and Quality Assurance, driving strategies aligned with Astiva’s goals.

You will lead a team, ensure compliance with federal and state requirements, and collaborate with senior management to improve STAR measures, HEDIS, and RAF data through robust reporting and program development.

Qualifications

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

Responsibilities

• Develop strategy, deploy systems, refine workflows, and ensure compliance in Quality Management, QI, and Quality Assurance.
• Maintain compliance with state and federal reporting standards.
• Collaborate with senior management on STR and STARS improvement.
• Lead initiatives to enhance HEDIS, CAHPS, HOS, and other STARS metrics.
• Design and supervise reporting protocols to align deliverables with budgets.
• Review and update QI programs and Medicare policies annually.
• Develop quarterly reporting processes for QI activity progress.
• Ensure adherence to applicable laws and regulations.
• Coordinate with internal departments to uphold QI program policies.
• Prepare reports on performance metrics for medical groups, IPA, and primary care providers.
• Facilitate discussions during Utilization Management/QA Committee and Board meetings.
• Analyze RAF data and conduct audits to improve risk adjustment documentation.
• Recruit and develop staff; manage succession planning.

Skills

Managed Care Operations

QI Experience (Plan Level)

QI Program Building

Healthcare Payer Experience

Board Reporting

Strategic Planning

IPAs/ DMG Oversight

Leadership

Communication

Analytical

Travel flexibility

Education

Master’s in Public Health

RN/NP/BSN licensure

Job description

Astiva Health, Inc. in Orange, CA, seeks a Manager of Quality Improvement to oversee Quality Management, Quality Improvement, Risk Adjustment Factors, and Quality Assurance, driving strategies aligned with Astiva’s goals.

You will lead a team, ensure compliance with federal and state requirements, and collaborate with senior management to improve STAR measures, HEDIS, and RAF data through robust reporting and program development.