VICE PRESIDENT Medicare Stars-Medicare Advantage Health Plan-Remote

VICE PRESIDENT

Medicare Stars-Medicare Advantage Health Plan-Remote The French Group - 5.0 Virginia Beach, VA Job Details 10 hours ago Benefits Health insurance Qualifications Program design Program management Quality control within healthcare industry Medicare Managed care organization experience Presentations for conferences or internal meetings CMS Financial analysis CMS regulatory compliance Bachelor's degree Medicare regulations Leading team collaboration initiatives Healthcare financial management Operational excellence initiatives Healthcare performance metrics analysis Cross-functional team management Team motivation (leadership skill) Board relations Cross-functional communication Senior leadership Quality assurance within healthcare Full Job Description 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 757-362-0202