Director, Stars HEDIS Improvement and Operations – Preventive Measures

About the position Become a part of our caring community and help us put health first Stars is an organization that is responsible for improving health outcomes and advancing the care experience of our members and provider partners through quality solutions. Stars is committed to caring for our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures covering preventive care screenings, health condition management, health outcomes, patient experience, and plan operations. The Director, Stars HEDIS Improvement and Operations is responsible for overseeing the implementation, management, and continuous improvement of the Healthcare Effectiveness Data and Information Set (HEDIS) initiatives as part of the CMS Stars Program. This role will develop and implement strategies to improve clinical quality and performance metrics.

Responsibilities

• Serve as an internal expert on HEDIS Preventive Measures (currently BCS, COA, COL, OMW, DSF) technical specifications, regulatory changes, and CMS guidance
• Lead and be accountable for enterprise HEDIS performance by directing measure owners, synthesizing performance insights, and driving measurable improvement across all assigned measures
• Accelerate shared accountability for HEDIS improvement by clearly communicating Enterprise strategy, aligning stakeholders, and mobilizing action to deliver tangible results
• Develop and manage a strategic portfolio of improvement initiatives targeting key drivers of HEDIS performance and delivering measurable gains in clinical quality and health outcomes
• Collaborate with cross-functional teams to design, test, and scale interventions that drive measurable improvement in Star ratings
• Own initiative performance oversight and development of integrated operational reporting, providing regular executive-level insights and recommendations to Stars and executive leadership
• Lead analytics partners to develop robust, actionable reporting that prioritizes quality improvement and translates complex data into clear insights
• Develop strategic recommendations for program evolution and policy advocacy, including written summaries and talking points for engagement with CMS, industry groups, and internal stakeholders
• Oversee budget, vendor relationships and program delivery to ensure efficient execution and return on investment
• Lead and develop a team of high- performing direct reports of 7+ measure owners, fostering accountability, engagement, and sustained enterprise performance

Requirements

• Bachelor’s Degree
• 8+ years of experience in Medicare Advantage Stars and/or HEDIS, including accountability for enterprise-level quality performance and improvement strategy
• 5 years or more of people leadership experience, including leading high-performing teams
• Demonstrated experience leading complex, cross-functional operations in a Medicare Advantage or clinical quality environment
• Experience leading a portfolio of complex initiatives with a proven track record of delivering measurable performance improvement
• Experience driving enterprise strategy, including influencing senior leaders and aligning cross-functional stakeholders
• Demonstrated ability to lead effectively in fast-paced, high-accountability environments, managing competing priorities while maintaining focus on results
• Exceptional written and verbal communication skills, including the ability to present complex information clearly and confidently to executive audiences
• Proven ability to influence without authority and a track record of success leading through ambiguity
• Ability to interpret and leverage data and analytics to improve strategy and make recommendations

Nice-to-haves

• Masters degree (MPH, MBA, MHA, or equivalent) preferred
• Demonstrated subject-matter expertise in Medicare Advantage Stars, with deep ownership of HEDIS Preventive Measures performance and accountability for enterprise-level outcomes

Benefits

• Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

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