Director, Clinical Quality - Medicare Stars

Your Role

Blue Shield of California is seeking a Director of Clinical Quality – Medicare Stars to lead and advance the organization’s Stars and HEDIS strategy, execution, and performance oversight. This role is critical to maintaining and improving Medicare Star Ratings and HEDIS performance by driving initiatives focused on clinical gap closure, quality improvement, health outcomes, and member experience.

The Director will oversee the strategic roadmap, operational excellence, and performance oversight of multiple H-Contracts and future Medicare Advantage contracts. The position requires a dynamic leader with deep expertise in Stars, HEDIS, and quality improvement methodologies, as well as the ability to collaborate across clinical and operational functions to enhance performance outcomes and drive systemic change

Your Work

In this role, you will:

• Stars & HEDIS Strategy Development: Lead the enterprise-wide Stars and HEDIS improvement strategy, ensuring alignment with the Quality Roadmap and company goals to achieve optimal performance outcomes.
• Clinical Gap Closure & Quality Improvement: Develop and implement targeted interventions that address gaps in care and drive measurable Stars and HEDIS improvements across populations.
• Operational Readiness & Process Optimization: Oversee end-to-end operational processes, ensuring that clinical, data, and outreach teams are fully equipped to execute HEDIS Stars initiatives effectively.
• Stakeholder Engagement & Collaboration: Work across internal teams and external partners, including providers, vendors, and regulatory agencies, to streamline quality initiatives and advance healthcare equity efforts.
• Performance Oversight & Monitoring: Develop and maintain robust reporting dashboards to monitor HEDIS Stars metrics, identify improvement opportunities, and enhance organizational accountability.
• Innovation & Data-Driven Decision Making: Lead test-and-learn initiatives to assess new strategies, leveraging insights from analytics to optimize Stars performance outcomes.
• Member Experience & Engagement: Design and implement strategies that improve the Medicare member experience, fostering higher engagement and satisfaction through quality healthcare interventions.
• Budget & Resource Management: Oversee Stars and HEDIS vendor relationships, operational budgets, and project/program management to drive efficient operations and maximize impact.
• Team Leadership & Development: Lead a team of high-performing professionals, fostering a culture of continuous learning, innovation, and accountability in Stars and HEDIS operations.
• Regulatory Compliance & Industry Leadership: Serve as an SME for Medicare Stars Ratings, HEDIS measures, and quality performance—ensuring compliance with CMS regulations while keeping Blue Shield at the forefront of industry best practices.

Your Knowledge and Experience

• Bachelor's degree required; Master’s in Public Health (MPH), Healthcare Administration (MHA), or related field preferred.
• 10+ years of healthcare experience leading large-scale, cross-functional programs focused on quality improvement.
• 6+ years of direct experience managing Stars and HEDIS performance initiatives with proven success in driving improvements.
• Strong ability to interpret complex healthcare data, develop insights, and apply analytics-driven strategies.
• Experience in Medicare Advantage quality programs, CMS requirements, and industry-leading Stars & HEDIS performance improvement techniques.
• Exceptional communication skills, with the ability to engage executive leadership, providers, and stakeholders effectively.
• Strong project management skills, with the ability to navigate tight deadlines, manage competing priorities, and lead strategic initiatives successfully.