VP, Quality, Stars & Risk Adjustment Operations

Monogram Health; United States; Presencial; USD 210.000 - 280.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Comprehensive Benefits

401k with employer match

Paid time off

Descripción de la vacante

Monogram Health is seeking a Vice President to lead Quality, Stars, Risk Adjustment, and Performance Operations. This role will drive enterprise strategy and execution across Medicare Advantage programs, quality metrics, and CDI while collaborating with finance, actuarial, and product teams to deliver measurable results.

The role requires 10+ years of healthcare leadership, with deep expertise in Stars, HEDIS, risk adjustment, and payer relationships.

Formación

• Bachelor's degree is required; master's degree preferred.
• Progressive healthcare leadership experience with 5+ years in Medicare Advantage Stars/HEDIS/Risk Adjustment is expected.

Responsabilidades

• 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.
• Develop payer-specific strategies reflecting contractual requirements, performance methodologies, financial incentives, data availability, and opportunities.
• Own trusted scorecards, forecasts, and reporting with validated data across clinical, payer, CMS, and financial sources.
• Partner with Finance, Actuarial, and Medical Economics to quantify revenue, costs and margins.
• Translate opportunities into scalable clinical and operational workflows across teams.
• Lead governance and executive reviews, remove barriers, and ensure accountability for results.
• Manage payer relationships, data/methodology issues, contracts, SLAs and ROI.
• Oversee coding, clinical documentation integrity, audits, and data submission controls for compliance.
• Build and retain a high-performing multidisciplinary team and educate stakeholders on regulatory, Stars, HEDIS, and risk model changes.

Conocimientos

Healthcare leadership

Medicare Advantage Stars

HEDIS

Risk Adjustment

Regulatory compliance

Team leadership

Analytical skills

Financial analysis

Medicare Advantage payer relationships

Value-based contracts

Coding

Audit

Cross-functional leadership

Educación

Bachelor's degree

Master's degree

Descripción del empleo

Monogram Health is seeking a Vice President to lead Quality, Stars, Risk Adjustment, and Performance Operations. This role will drive enterprise strategy and execution across Medicare Advantage programs, quality metrics, and CDI while collaborating with finance, actuarial, and product teams to deliver measurable results.

The role requires 10+ years of healthcare leadership, with deep expertise in Stars, HEDIS, risk adjustment, and payer relationships.