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. 

Job Description

The Manager, Stars and Quality Improvement Programs plays a critical leadership role in advancing quality performance for the Medicare Advantage population, with a specialized focus on medication-related quality measures. This includes driving improvements in Part D Star Ratings, particularly around medication adherence and comprehensive medication use. The ideal candidate brings deep expertise in pharmacy or medication management and a strong background in Medicare Advantage, HEDIS®, NCQA, and CMS Stars strategy.

WHAT YOU’LL BE DOING

• Provide strategic direction and oversight for all Medicare Advantage quality initiatives, with a strong focus on Part D Star Ratings, HEDIS® medication measures, and year-over-year performance improvement.
• Lead and develop a high-performing team of quality professionals, including staffing, coaching, performance management, and professional development.
• Manage and scale medication adherence interventions (e.g., pharmacy outreach, refill programs, synchronization, and care coordination).
• Collaborate with clinical, pharmacy, and analytics teams to design and implement targeted strategies that improve medication-related outcomes
• Analyze performance trends, identify opportunities, and develop data-driven action plans to close care gaps and enhance adherence.
• Prepare and deliver presentations to executive leadership, clients, and internal stakeholders, providing updates on project status, performance trends, and strategic recommendations.
• Lead client-facing discussions and represent the organization as a subject matter expert in medication-related Stars and quality improvement initiatives.
• Oversee quality dashboard reporting (HEDIS®, Stars, and other metrics) to guide internal strategy, value-based contracting, and performance tracking.
• Ensure CMS audit readiness, including data validation, documentation, monitoring, and corrective action plan development.
• Coordinate efforts to reduce polypharmacy risks and improve therapeutic outcomes through cross-functional collaboration.
• Develop member and provider educational materials to support performance on key quality measures.
• Maintain and update quality-related policies and procedures; participate in policy and quality committees as needed.
• Oversee Vendor relationships (e.g., data abstraction, reporting tools, engagement platforms).
• Support departmental operations including budgeting, resource planning, and contract alignment.
• Partner with the QI Director on team structure, staffing, onboarding, and strategic implementation.
• Serve as a subject matter expert in medication quality measures, CMS Part D guidelines, and NCQA pharmacy-related standards.
• Lead the creation and maintenance of quality policies and procedures; participate in policy committee meetings as needed.
• Prepare and present executive-level reports and updates to leadership, steering committees, and regulatory bodies.
• Serve as a liaison across clinical, informatics, compliance, and executive teams to align strategy and ensure data-informed decision-making.

Qualifications

WHAT YOU'LL NEED TO HAVE

• Active license as a Registered Nurse (RN), Licensed Practical Nurse (LPN), Pharmacist, or related clinical discipline (master’s degree preferred)
• Minimum 7+ years of progressive experience in healthcare quality improvement, with a focus on Medicare Advantage and Stars performance programs.
• Minimum of 3 years of experience managing or supervising staff, including team development, mentoring, and performance management.
• Deep expertise in Part D Star Ratings, HEDIS® medication measures, NCQA pharmacy standards, and CMS regulatory expectations.
• Proven ability to design and execute data-driven quality initiatives that improve Stars metrics and clinical outcomes.
• Strong cross-functional leadership experience, working with clinical, analytics, operations, and provider engagement teams.
• Skilled in interpreting complex performance data and developing actionable strategies to drive improvement.