Manager, Quality and Stars, Health Plan

**Careers With Purpose** **Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland.** **Facility:** Remote SD (Central Time) **Location:** Remote, SD **Address:** **Shift:** Day **Job Schedule:** Full time **Weekly Hours:** 40.00 **Job Summary** The Manager, Quality & Stars is responsible for identification, development and implementation of strategic programs with significant focus on Health Plan ratings and performance monitoring for governmental agencies, including CMS Star Ratings and BadgerCare HMO Pay-for-Performance. This position works collaboratively with internal teams, provider partners and vendors to develop implement and monitor continuous improvement plans that includes programs, services and tactics to allow the Health Plan to lead the industry in quality programs designed to improve member experience and clinical outcomes. This strategic leadership role oversees the organization's value-based performance, with a primary focus on the CMS Medicare Star Ratings program, BadgerCare Pay-for-Performance, and NCQA technical specifications. The individual is responsible for the end-to-end management of the Stars Program, from analyzing regulatory guidance and identifying performance risks to implementing tactical work plans and dashboards that track intervention success. By collaborating across departments and with data analytics partners, they drive improvements in clinical care, provider engagement, and member communication to maximize quality scores and ensure compliance with evolving federal requirements. In addition to technical and analytical oversight, the position serves as a central subject matter expert and people leader. The individual is responsible for educating the organization on the financial and operational impacts of improved ratings, managing external vendor relationships, and presenting performance strategies to senior leadership. As a manager, they are tasked with coaching, mentoring, and developing their team, ensuring staff are well-equipped to navigate complex quality rating systems like the Marketplace QRS. Additional duties as assigned. **Qualifications** Bachelor’s degree in business administration, healthcare administration, or related field required. Masters degree preferred. Five years of experience in managing quality or performance in the payor or provider space, required. Demonstrated outcomes and knowledge of reporting and analysis of healthcare related data. Experience in project management in healthcare industry and/or experience in health plan quality performance and ratings, preferred. **Benefits** Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, and a generous time off package to maintain a healthy home-work balance. For more information about Total Rewards, visit https://sanfordcareers.com/benefits . Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org . Sanford has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment. **Req Number:** R-0263416 **Job Function:** Health Plan **Featured:** No