Director, Clinical Quality Performance & Improvement

Role Overview

• Lead annual and multi-year Medicare Stars strategy development, translating priorities into detailed operational plans while monitoring CMS rulemaking and providing leadership recommendations on program implications.
• Serve as organizational expert on Medicare Stars requirements, measure specifications, and CMS methodology, ensuring enterprise-wide understanding of priorities and cascading goals across cross-functional teams.
• Lead Stars analytics operations including measure-level tracking, forecasting models, root cause analysis, and financial impact assessments.
• Deliver actionable performance insights through deep-dive analyses of underperforming measures, trend identification, and executive-level reporting to drive quality improvements.
• Drive cross-functional Stars improvement initiatives by partnering with clinical operations, care management, pharmacy, provider relations, and operational leaders to implement and scale interventions.
• Facilitate Stars governance and technical operations including workstream coordination within enterprise quality structure, HEDIS engine optimization, data validation, and vendor management collaboration.
• Lead Stars Program operations and improvement initiatives by directing team priorities, overseeing quality improvement projects using Lean/Six Sigma methodologies, and maintaining real-time performance dashboards.
• Manage Stars reporting and compliance including executive presentations, quarterly business reviews, regulatory submissions, CMS reporting, data audits, and timely submission requirements.
• Lead and develop Stars program team by mentoring specialists and analysts in Medicare quality measurement, setting performance expectations, providing coaching and evaluations, and building team capacity to manage priorities and adapt to evolving CMS requirements.

Requirements

• Bachelor's degree in Healthcare Administration, Public Health, Nursing, Business Administration, or related field.
• Master's degree (MBA, MHA, MPH, or related) strongly preferred.
• 12+ years of progressive healthcare quality or performance improvement experience, including 8+ years of direct Medicare Stars program experience, including measure-level performance improvement and CMS reporting.
• 5+ years of people leadership experience with demonstrated success building and developing quality teams or equivalent combination of education and experience.
• CPHQ, Lean Six Sigma Green Belt or Black Belt, or PMP preferred.

Tech Stack

• PMP

Benefits

• Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.
• Annual employer contribution to a health savings account.
• Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.
• Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).
• Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).
• Award-winning wellness programs that reward you for participation.
• Employee Assistance Fund for those in need.
• Commute and parking benefits.