The Job

The Director of Stars and Quality will lead initiatives to achieve and sustain exceptional Medicare Star Ratings performance, with a strong focus on clinical quality metrics and prescription drug (Rx) adherence measures. This individual will oversee operational strategies, vendor partnerships, and cross-functional collaboration to drive quality improvement, member satisfaction, and compliance with regulatory requirements. You Will

Strategic Leadership: Develop and execute strategies to meet and exceed Medicare Stars performance targets. Drive improvement in clinical quality metrics, with a focus on Rx adherence measures (statin use, hypertension medication adherence, etc.). Monitor regulatory updates and ensure compliance with CMS Star Ratings requirements.

Clinical Metrics Management: Analyze performance data and trends for clinical metrics to identify improvement opportunities. Collaborate with clinical teams to develop and implement interventions to enhance outcomes. Lead efforts to optimize medication adherence programs and support pharmacy-related initiatives.

Operational Excellence: Oversee daily operations related to quality initiatives, ensuring seamless execution and alignment with organizational goals. Develop processes to streamline workflows, enhance efficiency, and achieve measurable results. Foster a culture of continuous improvement and accountability across teams.

Vendor Oversight: Manage relationships with external vendors, ensuring contractual obligations and quality deliverables are met. Evaluate vendor performance through established metrics and implement corrective actions when necessary. Serve as the primary liaison between vendors and internal stakeholders, promoting collaboration and alignment.

Cross-Functional Collaboration: Partner with member experience, healthcare services, pharmacy, and IT teams to design and execute initiatives. Communicate performance outcomes and improvement plans to executive leadership and stakeholders. Lead or participate in workgroups to address system-wide challenges affecting Stars performance.

We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Actively support the achievement of SCAN’s Vision and Goals.

Other duties as assigned. Your Qualifications

Bachelor's Degree or equivalent experience required.

Graduate or Advanced Degree or equivalent experience preferred.

7+ years of experience in a Medicare managed care or provider organization preferred.

7+ years of experience in Medicare Star rating program preferred.

Leadership - Skilled to develops others

Business Insight - In-Depth understanding of the business

Problem Solving - Good problem solving skills

Strategic Mindset - Creates strategies to sustain competitive advantage

Strong verbal and written communication skills.

Ability to analyze and synthesize complex information.

Excellent organizational, decision-making, and multi-tasking skills.

Ability to prioritize multiple and competing tasks, work independently and in a team environment.

Proficient in MS Office. What's in it for you? Base salary range: $147, to $211,530 per year

Work Mode - Remote (anticipated travel to Long Beach, CA office is 1-2 times per month)

An annual employee bonus program

Robust Wellness Program

Generous paid-time-off (PTO)

Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday

Excellent 401(k) Retirement Saving Plan with employer match and contribution

Robust employee recognition program

Tuition reimbursement

An opportunity to become part of a team that makes a difference to our members and our community every day!