Director, Stars Provider Engagement & Operations

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Director, Provider Engagement is responsible for overseeing a team of four, driving per-formance improvement across HEDIS, CAHPS, HOS, and Part D measures with a focus on IPA and provider engagement. This role ensures the effective execution of Stars program operations, collaborates with internal teams, market network teams, and IPAs, and develops strategies to achieve high Star ratings. The director will proactively adapt to annual CMS Star rating changes, streamline Stars program operations, develop actiona-ble insights, and implement strategic initiatives to optimize provider performance.

Job Duties/Responsibilities:
1.    Oversees Stars program operations, ensuring efficiency, compliance, and strategic execution of Stars initiatives across CA, NV, AZ, NC, and TX.
2.    Manages HEDIS, CAHPS, HOS, and Part D performance through data-driven strategies and operational improvements.
3.    Supervises and mentors a team, fostering a culture of accountability, execution, and continuous im-provement.
4.    Develops and optimizes Stars program workflows, ensuring alignment between provider engagement, quality improvement, and operational execution.
5.    Implements process improvements and automation to enhance the efficiency of Stars reporting, data reconciliation, and performance tracking.
6.    Leads provider engagement initiatives, working closely with market network teams and IPAs to en-hance Stars performance.
7.    Presents performance updates, operational insights, and strategies to CEOC-level leadership with a strong focus on data storytelling.
8.    Ensures alignment between HEDIS, CAHPS, and Stars teams, optimizing strategies and operational processes to improve outcomes.
9.    Adapts to CMS changes in Star ratings on an annual basis, ensuring operational readiness and strate-gic agility.
10.    Collaborates with cross-functional teams (e.g., Quality, Network, IT, Analytics) to drive seamless Stars operations and performance management.
11.    Establishes regular JWG touchpoints with IPAs and market teams, ensuring clear communication, ac-countability, and operational efficiency.
12.    Monitors key performance indicators (KPIs) and operational metrics, identifying trends and areas for improvement.

Supervisory Requirements:

Fulfill supervisory responsibilities in accordance with organization policies and applicable laws.  Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

Job Requirements:

Experience:

• Required: Minimum 3 years of experience as a Director, with experience managing operations, provider engagement, and Stars performance improvement. Minimum of 3 years of executive-level presentations and communication at the C-Suite Board level. Minimum 2 years of experience in IPA/provider engagement, performance monitoring, and implementing operational efficiencies to improve Star ratings.

• Preferred: 10 Years provider engagement experience in Healthcare.

Education:

• Required: Bachelor's degree.

• Preferred: Master’s degree in Healthcare Administration, Public Health, Business, or a related field.

Training:

• Preferred: Additional training or certifications in quality improvement, healthcare operations, or provider engagement.

Specialized Skills:

• Required:

• Solid expertise in Stars program operations, including deep knowledge of HEDIS, CAHPS, HOS, and Part D measures.
• Solid operational management, workflow optimization, and process improvement experience.
• Ability to analyze complex data, generate actionable insights, and implement performance improvement strategies.
• Expertise in Stars program details, CMS guidelines, and adapting to evolving requirements.
• Experience collaborating with network teams, IPAs, and provider groups to improve Stars performance.
• Results-oriented mindset with a proactive approach to problem-solving and execution.
• Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Mathematical Skills:  Ability to perform mathematical calculations and calculate simple statistics correctly
• Reasoning Skills:  Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Problem-Solving Skills:  Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills:  Comprehend and analyze statistical reports.

Licensure:

• Required: None

• Preferred: PMP, Six-Sigma, quality improvement, healthcare operations, or provider engagement.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $109,932.00 - $164,899.00

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.

Salary : $109,932 - $164,899