Director, Quality Improvement & STARs - Medicare - Pearland, TX

Primary Responsibilities

The Director leads the development and execution of the health plan's Quality and STARs improvement strategy, ensuring solid HEDIS and STARs performance. This role establishes key objectives related to clinical gap closure, disease management, health outcomes, and member experience.

Required Qualifications

• 8+ years of leadership/management experience in the Health Plan Industry and Operations, including experience in HEDIS clinical quality and process improvement
• 8+ years in customer retention or a role requiring relationship management and/or marketing/sales and/or program development and measurement
• Experience with NCQA's HEDIS data submission process and audits
• Proven knowledge of CMS Quality Ratings, Stars ratings and NCQA accreditation measurements and methodologies
• Experience in provider education programs
• Proven working knowledge of CMS Risk Adjustment requirements

Preferred Qualifications

• 5+ years of experience in health plan operations
• Ability to be a critical thinker, evaluate merits of new and innovative ideas, and make sound decisions
• Demonstrated solid influence, and the ability to partner with Clinical resources to enable practice transformation
• Ability to create solid relationships and work with Clinical Directors, Medical Directors, Sr. Leadership, as well as business and technology partners to plan, direct and develop clinical programs
• Ability to be a solid communicator and extremely comfortable presenting program objectives, scope, and process across segments

Pay and Benefits

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Benefits

• Life
• Emotional
• Physical
• Financial