Director, Clinical Quality - Medicare Stars

Your Role

Blue Shield of California is seeking a Director of Clinical Quality – Medicare Stars to lead and advance the organization’s Stars and HEDIS strategy, execution, and performance oversight. This role is critical to maintaining and improving Medicare Star Ratings and HEDIS performance by driving initiatives focused on clinical gap closure, quality improvement, health outcomes, and member experience.

The Director will oversee the strategic roadmap, operational excellence, and performance oversight of multiple H-Contracts and future Medicare Advantage contracts. The position requires a dynamic leader with deep expertise in Stars, HEDIS, and quality improvement methodologies, as well as the ability to collaborate across clinical and operational functions to enhance performance outcomes and drive systemic change

Your Knowledge and Experience

• Bachelor's degree required; Master’s in Public Health (MPH), Healthcare Administration (MHA), or related field preferred.
• 10+ years of healthcare experience leading large-scale, cross-functional programs focused on quality improvement.
• 6+ years of direct experience managing Stars and HEDIS performance initiatives with proven success in driving improvements.
• Strong ability to interpret complex healthcare data, develop insights, and apply analytics-driven strategies.
• Experience in Medicare Advantage quality programs, CMS requirements, and industry-leading Stars & HEDIS performance improvement techniques.
• Exceptional communication skills, with the ability to engage executive leadership, providers, and stakeholders effectively.
• Strong project management skills, with the ability to navigate tight deadlines, manage competing priorities, and lead strategic initiatives successfully.