Director Medicare Stars

About the Position:

Reporting to the Chief Quality Officer, the Director of Medicare Stars is responsible for leading the strategic direction, execution, regulatory compliance, and continuous performance improvement of the Medicare Star Ratings program at IEHP. This role will oversee enterprise-wide cross-functional initiatives to drive quality outcomes, enhance member experience, and ensure compliance with the Center of Medicare & Medicaid Services (CMS) Star Ratings requirements. The Director develops and implements data-driven strategies that improve performance across all Star measures in collaboration with clinical, operational, IT, and analytics team. By providing strategic oversight, fostering cross-functional collaboration, and leveraging data-driven insights, the Director will ensure IEHP not only meets, but exceeds CMS expectations enhancing quality outcomes, member experience, plan reputation, financial incentives, and driving sustainable growth.

Responsibilities:

• Lead the strategic planning and execution of the Medicare Stars strategy to achieve and sustain 4 Star Ratings across all domains.
• Oversee the design, implementation, and evaluation of enterprise-wide quality improvement initiatives aligned with CMS Star Ratings and associated measures.
• Direct cross-functional collaboration with internal stakeholders (e.g., Quality, Pharmacy, Provider Relations, Member Services, IT, and Compliance) to drive integrated performance improvement strategies.
• Monitor and interpret Star Ratings performance data, trends, and CMS cut points, and regulatory trends to proactively identify risks and opportunities.
• Develop predictive models and dashboards in collaboration with analytics teams to forecast performance and guide interventions.
• Serve as the organizational subject matter expert on CMS Star Ratings methodology, regulatory updates, and technical specifications; ensure timely dissemination of updates and compliance.
• Lead the development of executive-level presentations, strategic recommendations, and performance briefings for senior leadership and governance bodies.
• Champion a culture of quality, accountability, and continuous improvement across the organization.
• Manage and mentor a team of professionals, fostering growth and alignment with organizational goals. Conduct performance reviews of each Team Member within IEHP guidelines.
• Perform any other duties as required to ensure Health Plan operations and department business needs are successful.

Experience Requirements:

Required: Seven (7) years of progressive experience in Medicare Advantage, quality improvement in a health plan setting or health plan operations. Three (3) years of leadership experience managing teams or large-scale cross-functional initiatives. Proven track record of driving performance improvement and achieving quality benchmarks.

Preferred: Proven track record of improving Star Ratings performance preferred. Experience working with NCQA, CMS audits, or Medicare Advantage plan operations preferred.

Educational Requirements:

Required: Bachelor’s degree in Health Administration, Public Health, Business Administration, or a related field from an accredited institution required.

Preferred: Master’s Degree (MPH, MHA, MBA, or related) from an accredited institution preferred.