Program Manager, Medicare Stars & Quality Improvement

Job Summary

Provides subject matter expertise and leadership for Medicare Stars quality improvement (QI) programs and activities. Plans and implements QI initiatives and education programs to support improved Medicare Star ratings. Leads and manages Medicare Star projects and programs across enterprise, department, cross‑functional, and health‑plan teams, delivering impactful quality improvement initiatives from design through outcomes measurement.

Essential Job Duties

• Collaborates with cross‑functional corporate and health‑plan teams to develop and implement enterprise Medicare Stars QI programs and initiatives.
• Manages, plans, and executes Medicare Star ratings programs, supporting execution, governance, outcome measurement, and initiative development.
• Serves as the Medicare Stars subject matter expert to corporate functional areas and health plans, leading programs to meet critical needs.
• Communicates and collaborates with health plans and Stars measure owners to translate needs and goals into functional requirements.
• Leads health‑plan leadership discussions, providing recommendations, performance results, and opportunity assessments for Medicare Stars improvement.
• Works with operational leaders to recommend process improvements, organizational change management, and program management related to Star ratings.
• Facilitates process improvement, organizational change management, and program management for the Medicare Stars Program.
• Plans and directs schedules and budgets for program initiatives.
• Develops, defines, and executes plans, schedules, and deliverables; monitors programs from initiation through delivery and outcomes measurement.
• Monitors and tracks key performance indicators (KPIs), programs, and initiatives to demonstrate value and effectiveness of Stars and QI programs.
• Creates business requirements documents, test plans, requirements traceability matrices, user training materials, and related documentation.
• Oversees projects from inception through delivery and outcomes measurement, including engagement of external vendors as needed.
• Generates and distributes quality improvement/Medicare Stars standard reports in a timely manner.

Required Qualifications

• At least 6 years of Medicare Stars program and project management experience, or an equivalent combination of relevant education and experience.
• Demonstrated knowledge of and experience with Medicare Star ratings and QI programs.
• Advanced knowledge of the quality discipline, including metrics and performance standards.
• Experience with government‑sponsored programs (Medicaid, Medicare, Marketplace).
• Experience developing performance measures that support business objectives.
• Solid business writing experience.
• Strong strategic‑thinking, critical‑thinking, problem‑solving, and analytical skills.
• Proficiency in data analysis, manipulation, interpretation, reporting, and data‑driven decision‑making.
• Attention to detail and strong organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast‑paced, deadline‑driven environment.
• Ability to work in a cross‑functional, highly matrixed organization.
• Strong project management experience.
• Excellent verbal, written, and presentation communication skills.
• Proficiency with Microsoft Office suite (including Excel) and ability to learn new information systems and software programs.

Preferred Qualifications

• Strong Medicare Stars/quality improvement (QI) program experience.
• Six Sigma Black Belt Certification.
• ITIL (Information Technology Infrastructure Library) certification.
• Experience leading significant cross‑functional work.
• Additional strong project management experience.

Pay

Pay Range: $65,791.66 – $142,548.59 annually. Actual compensation may vary based on geographic location, work experience, education, and/or skill level.