VP, Quality, Stars & Risk Adjustment Operations

Monogram Health; Brentwood (TN); On-site; USD 210,000 - 280,000; Full time

Benefits offered by this job

Comprehensive Benefits

401k with employer match

20 PTO days + 7 holidays + floating

Job summary

Monogram Health seeks a Vice President, Quality, Stars, Risk Adjustment and Performance Operations to lead enterprise strategy and execution across Medicare Advantage, quality metrics, risk adjustment, CDI, and compliance.

You will partner with Finance, Actuarial, Medical Economics, and product teams to translate strategy into scalable workflows, define requirements, and drive measurable performance improvements; build governance and executive reporting to guide decisions.

Qualifications

• Bachelor’s degree in healthcare, business, public health, or related field.
• 10+ years of healthcare leadership, including 5+ years in Medicare Advantage Stars or related programs.
• Ability to build and lead professional and large-scale operational teams in a fast-paced, matrixed environment.
• Advanced analytical and financial skills for translating data into executive decisions.
• Experience with Medicare Advantage payer relationships, value-based contracts, Stars incentives, risk adjustment economics, coding, audit and performance methodology issues.

Responsibilities

• Lead enterprise strategy and end-to-end performance for Quality, Stars, HEDIS, Risk Adjustment, and CDI.
• Set annual and long-range goals, operating plans, milestones, and accountability; drive execution and corrective action.
• Develop payer-specific strategies reflecting contractual requirements, performance methodologies, financial incentives, data availability, and operational opportunities.
• Own trusted scorecards, forecasts, and reporting with clear definitions and validated data across sources.
• Forecast revenue, medical cost, and margin implications with Finance, Actuarial, and Medical Economics.
• Translate opportunities into scalable clinical and operational workflows with cross-functional teams.
• Lead governance and executive reviews, remove barriers, and ensure accountability.
• Manage payer relationships and external partners, including data/methodology issues and contractual discussions.
• Oversee coding, clinical documentation integrity, audit, and submission controls for regulatory compliance.
• Build a high-performing, multidisciplinary team and educate stakeholders on regulatory and risk model changes.

Skills

Strategic leadership

Financial analysis

Executive communication

Healthcare operations

CMS payer relationships

Education

Bachelor’s degree

Master’s degree preferred

Job description

Monogram Health seeks a Vice President, Quality, Stars, Risk Adjustment and Performance Operations to lead enterprise strategy and execution across Medicare Advantage, quality metrics, risk adjustment, CDI, and compliance.

You will partner with Finance, Actuarial, Medical Economics, and product teams to translate strategy into scalable workflows, define requirements, and drive measurable performance improvements; build governance and executive reporting to guide decisions.