Manager, Stars and Quality Improvement Programs - Remote

Company Description

WHO IS GUIDEHEALTH? 

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients.  

We are currently accepting applications for local candidates who reside or plan to reside within a 90-minute drive of the Metro-Atlanta, GA area only. We thank you for your understanding. 

Job Description

The Manager, Stars and Quality Improvement Programs is responsible for leading and managing the Medicare Advantage quality improvement program. This includes oversight of regulatory and accreditation requirements (CMS, NCQA, HEDIS®, MIPS), quality reporting, audit readiness, and performance improvement initiatives aimed at enhancing member outcomes and provider engagement.

WHAT YOU’LL BE DOING

• Leading and managing all quality initiatives for the Medicare Advantage line of business, with a strong focus on CMS Star Ratings, HEDIS®, CAHPS®, and HOS performance and driving measurable improvements in medication adherence.
• Coordinating and overseeing annual HEDIS® reporting and audits, including roadmap development, data validation, vendor coordination, analysis, and NCQA submission with particular attention to medication-related measures (e.g., adherence for diabetes, hypertension, and cholesterol).
• Supervising the MIPS submission process (where applicable to affiliated provider networks), ensuring data integrity and timely reporting.
• Managing quality dashboard reporting (HEDIS®, Stars, and other metrics) to support internal strategy and value-based contracting efforts.
• Ensuring CMS audit readiness, leading efforts in data validation, monitoring, documentation, and corrective action plans.
• Designing and implementing targeted interventions to improve adherence, reduce readmissions, and close care gaps.
• Managing and mentoring the Quality and Performance Improvement team, including staff development, performance management, and ongoing training.
• Collaborating across clinical, operational, analytics, compliance, and provider teams to identify gaps and drive evidence-based quality improvements.
• Developing member and provider education materials to support performance on key quality measures.
• Serving as a subject matter expert on CMS, NCQA, HEDIS®, and other regulatory and accreditation standards.
• Leading the creation and maintenance of quality policies and procedures; participating in policy committee meetings as needed.
• Preparing and presenting executive-level reports and updates to leadership, steering committees, and regulatory bodies.
• Oversee vendor relationships for data abstraction, reporting platforms, and engagement tools.
• Supporting departmental operations including budget oversight, resource planning, and contract alignment.
• Partnering with the QI Director on team structure, new client onboarding, staffing, and implementation strategies.
• Demonstrating strong communication, leadership, and problem-solving skills in a fast-paced, evolving healthcare environment.
• Leveraging quality incentive structures to identify high-impact opportunities and drive outcomes in the Medicare Advantage population.

Qualifications

WHAT YOU'LL NEED TO HAVE

• Bachelor’s degree in nursing, Public Health, Healthcare Administration, or related field (master’s preferred).
• Minimum 7 years of experience in healthcare quality improvement, preferably within managed care or Medicare Advantage.
• Strong knowledge of HEDIS®, MIPS, NCQA, CMS Star Ratings, and related quality programs.
• Hands-on experience leading the HEDIS® audit process, including collaboration with vendors, oversight of abstraction, and adherence to NCQA audit standards.
• Experience in data-driven quality initiatives, quality measure analysis, and performance improvement planning.
• Demonstrated success in managing cross-functional teams and leading complex quality projects.
• Proven ability to build, coach, and manage a high-performing team.
• Exceptional communication, leadership, and organizational skills.

WHAT WE WOULD LOVE FOR YOU HAVE

• Certification in healthcare quality (e.g., CPHQ).
• Experience developing provider performance incenti