Medicare Quality Manager Jobs (NOW HIRING)

Your Role
Reporting to the Vice President, Quality, the Senior Director, Quality - Medicare STARs is a senior leader with expertise in developing STARs strategy, short- and long-term STARs initiatives, and oversight of STARs performance. The position will have responsibility for STARs quality improvement and performance for all lines of business with Medicare plans. You will serve as a strategic leader to develop, implement, and maintain the enterprise STAR quality improvement program in alignment with the overall Quality Roadmap and plan to achieve desired outcomes for members and on the overall impact of STARs performance for the organization at large.
Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow - personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Responsibilities
Your Work
In this role, you will:

• In partnership with the Vice President, Quality, serve as the accountable leader for Medicare Stars and HEDIS performance, including overall Star Ratings, measure-level outcomes, quality performance, and associated financial results.
• Develop and lead the enterprise Medicare Stars strategy, translating organizational objectives, CMS requirements, and market dynamics into annual and multi-year priorities.
• Serve as the organization's subject matter expert on Medicare Stars methodology, CMS specifications, measure weighting, cut points, improvement methodology, and rating calculations, ensuring strategic decisions are aligned to program requirements and future performance opportunities.
• Establish and lead enterprise Medicare Stars governance, accountability, reporting, and escalation processes to ensure consistent ownership and execution across the organization.
• Define performance expectations and accountability for Medicare Stars and HEDIS measures across business units, operational departments, providers, and vendor partners.
• Influence and align leaders across Market, Clinical Operations, Provider Performance, Network Management, Pharmacy, Analytics, Member Experience, Operations, and other key functions to drive enterprise ownership of Stars outcomes.
• Lead provider engagement and performance improvement strategies, including provider incentives, quality-focused value-based arrangements, provider education, and performance transparency initiatives.
• Drive member engagement, preventive care, health equity, and member experience strategies to improve measure performance, close care gaps, and enhance overall Stars results.
• Foster an enterprise culture of accountability and quality excellence, ensuring Medicare Stars performance is understood and owned throughout the organization.
• Accountable for Medicare HEDIS performance, including overall quality results, measure-level outcomes, annual improvement targets, and regulatory performance.
• Ensure enterprise-wide compliance with CMS, NCQA, DMHC, and other applicable regulatory, accreditation, and reporting requirements.
• Evaluate and communicate Medicare Stars performance, risks, opportunities, financial implications, and strategic recommendations to executive leadership, quality committees, and governing bodies.
• Serve as a trusted strategic advisor to executive leadership on Medicare quality strategy, Stars methodology, regulatory requirements, emerging trends, and organizational readiness priorities.
• Lead Medicare Stars forecasting, scenario modeling, performance monitoring, root cause analyses, and recovery strategies to proactively manage performance risk and maximize Star Rating outcomes.

Qualifications
Your Knowledge and Experience

• Bachelor's degree or High School Diploma/GED and 4 years of additional relevant experience in lieu of a degree.
• Master's degree in relevant field (e.g. MHA, MBA, MPH or similar) is preferred.
• 12 years prior relevant experience is required.
• 6 years of prior people management experience with direct responsibility for supervising, coaching, and evaluating direct reports is required.
• Expert knowledge of Medicare STARs required.
• Previous experience leading quality and performance improvement for a health plan.

Hybrid
This role requires employees to be in-office based on our hybrid workplace model, balancing purposeful in-person collaboration with flexibility. For most teams, this means coming into the office two days each week.
Employees living more than 50 miles from an office location will work with their manager to determine in-office time based on business need.
About the Team
About Blue Shield of California
As of January 2025, Blue Shield of California became a subsidiary of Ascendiun. Ascendiun is a nonprofit corporate entity that is the parent to a family of organizations including Blue Shield of California and its subsidiary, Blue Shield of California Promise Health Plan; Altais, a clinical services company; and Stellarus, a company designed to scale healthcare solutions. Together, these organizations are referred to as the Ascendiun Family of Companies.
At Blue Shield of California, our mission is to create a healthcare system worthy of our family and friends and sustainably affordable. We are transforming health care in a way that genuinely serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To achieve our mission, we foster an environment where all employees can thrive and contribute fully to address the needs of the various communities we serve. We are committed to creating and maintaining a supportive workplace that upholds our values and advances our goals.
Blue Shield is a U.S. News Best Company to work for, a Deloitte U.S. Best Managed Company and a Top 100 Inspiring Workplace. We were recognized by Fair360 as a Top Regional Company, and one of the 50 most community-minded companies in the United States by Points of Light. Here at Blue Shield, we strive to make a positive change across our industry and communities - join us!
Our Values:

• Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short.
• Human. We strive to listen and communicate effectively, showing empathy by understanding others' perspectives.
• Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals.

Our Workplace Model
We believe in fostering a workplace environment that balances purposeful in-person collaboration with flexibility - providing clear expectations while respecting the diverse needs of our workforce. Our workplace model is designed around intentional in-person interaction, collaboration, connection, creativity and flexibility:

• For most teams, this means coming into the office two days per week.
• Employees living more than 50 miles from an office location, out of state employees, and employees in certain member-facing roles should work with their manager to determine in-office time based on business need.
• For employees with medical conditions that may impact their ability to work in-office, we are committed to engaging in an interactive process and providing reasonable accommodations to ensure their work environment is conducive to their success and well-being.

The Company reserves the right to require more presence in the office based on business needs, and requirements are subject to change with periodic reviews.
Physical Requirements:
Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
Please click here for further physical requirement detail.
Equal Employment Opportunity:
External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.