VICE PRESIDENT Medicare Stars-Medicare Advantage Health Plan-Remote
Unique opportunity for a talented QI/Stars executive to create and lead CMS Stars/HEDIS Program within a growing, multi-state health plan affiliated with one of the nation’s largest leaders in post-acute care. The VP Medicare Stars is a highly visible executive role requiring significant Stars expertise, strong executive influence, and the ability to drive results across a dynamic, complex organization.
Summary
The VP Medicare Stars designs and leads the strategy, execution, and performance improvement of Medicare Advantage quality programs, ensuring the organization achieves and sustains 4.0+ Star ratings and strong HEDIS outcomes. This highly visible role blends enterprise‑level strategy, data analytics, provider engagement, regulatory oversight, and cross‑functional leadership.
Key Responsibilities
Strategic Leadership & Program Ownership
- Design and continuously refine an enterprise-wide Stars and HEDIS strategy across all quality domains to achieve 4.0+ CMS Star ratings.
- Serve as the organization’s subject matter expert and spokesperson on Stars.
- Ensure compliance with CMS regulations and translate CMS technical specifications into operational workplans.
- Continually monitor regulatory changes and competitive landscape to keep strategy agile.
- Foster a culture of accountability and operational excellence via strategic leadership, cross-functional collaboration and empowering high-performing teams.
Performance Management, Reporting & Analytics
- Oversee all Stars and HEDIS performance outcomes, KPIs, and reporting to executive leadership and the Board.
- Lead advanced data analytics to identify gaps, root causes, improvement opportunities and assess financial impact.
- Prioritize measures and design workflows to close gaps.
Provider & Cross Functional Engagement
- Strengthen provider partnerships focused on Star quality measure success through joint quality committees and performance reviews.
- Communicate strategy and results with and empower key stakeholders to ensure alignment and execution.
- Lead collaboration and oversight cross-functionally across health plan, Primary Care Practices, and nursing facilities to align initiatives.
Operational Oversight
- Oversee budget and resource allocation for all Stars/HEDIS initiatives to support operational excellence and revenue optimization.
- Lead development of systems and processes supporting quality operations.
- Lead the strategic initiatives in driving HEDIS and Stars performance across cross functional roles.
- Ensure the organization maintains competitive, compliant, and financially optimized quality programs
Required Qualifications
- Bachelor’s degree in Healthcare Administration, Public Health, Nursing, Business, or related field; Master’s degree preferred.
- 10+ years of progressive healthcare leadership experience, including Medicare Advantage and value-based care, ideally in a provider-sponsored health plan. ISNP experience preferred.
- Deep expertise in CMS Medicare Advantage Star Ratings methodology and operations.
- Extensive HEDIS and Stars program design and oversight.
- Demonstrated success leading enterprise-wide quality or Stars improvement initiatives. Prior accountability for achieving or sustaining 4+ Stars.
- Strong financial and analytical acumen with demonstrated impact on revenue or quality outcomes.
- Exceptional communication and presentation skills including Board presentations.
- Inspirational and cross-functional leadership style with proven experience influencing providers, executive leadership and leaders at all levels to achieve measurable performance outcomes.
Consultant
Tricia French, RN, BSN
President & CEO
The French Group
tfrench@frenchgroup.com
757-362-0202