Senior Director of Quality Improvement and Stars

4 weeks ago


San Francisco, California, United States Alignment Healthcare Full time
Job Summary

The Senior Director of Quality Improvement and Stars will lead and drive the strategic development, implementation, and oversight of quality improvement initiatives aimed at optimizing clinical outcomes and achieving 5-star ratings in our Medicare Advantage plans.

Key Responsibilities
  • Strategic Leadership: Provide strategic direction for the Quality and Stars program, focusing on achieving and maintaining a 5-star rating by implementing robust quality improvement frameworks.
  • Performance Management: Oversee the measurement, tracking, and reporting of key quality performance indicators (HEDIS and Part D) to ensure alignment with CMS regulations and organizational goals.
  • Stakeholder Engagement: Partner with clinical, operational, and network teams to develop action plans for addressing gaps in care, improving patient experience, and ensuring compliance with CMS Star measures.
  • Data-Driven Decision Making: Utilize healthcare data analytics to assess performance trends, identify opportunities for improvement, and develop targeted interventions that enhance member care and outcomes.
  • Process Improvement: Lead process improvement efforts across multiple departments, ensuring initiatives align with organizational objectives for clinical quality, patient safety, and regulatory compliance.
  • Team Leadership: Manage and mentor a team for Stars performance, ensuring continuous development of skills, knowledge, and leadership abilities within the team.
  • Collaboration and Influence: Cultivate cross-functional relationships with senior leadership, external stakeholders, and regulatory bodies to ensure effective coordination and implementation of quality initiatives.
Qualifications
  • Education: Bachelor's degree in Business Administration, Health Care Administration, Nursing, Public Health, or related field. Master's degree or PhD preferred.
  • Experience: Minimum of 10 years of experience in healthcare quality assurance/improvement, or a directly related field. At least 7 years of leadership experience in quality improvement, with a focus on Medicare Advantage, including direct oversight of Stars ratings.
  • Expertise: Proven experience managing large-scale quality improvement projects and operational budgets. Expertise in CMS star rating methodologies, HEDIS, CAHPS, and regulatory compliance.


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