Vice President Quality & Stars

The Vice President of Quality and Stars is a key leadership role responsible for overseeing and driving quality management and improvement initiatives across the health plan. The leader will work closely with various business unit leaders to ensure that optimal Star Ratings are achieved and sustained. This position plays a crucial role in ensuring the highest standards of care and service for our members, advancing Medica’s health equity strategy, and compliance with NCQA accreditation and other regulatory requirements. This VP, Quality and Stars role is responsible for the strategic direction and performance of the Medicare Stars programs, specifically focusing on achieving and maintaining a minimum of 4 stars in the CMS Star Ratings for all Medicare products, including D-SNP and MA-PD. This position requires a proven leader who can devise and implement effective strategies across the organization to enhance Medica’s performance in the CMS Star Ratings measures.

The VP, Quality and Stars will work closely with various business unit leaders to ensure that optimal Star Ratings are achieved and sustained. This role emphasizes the importance of collaboration and relationship-building with key stakeholders both within the organization and in the Provider Network to drive improvements in quality outcomes and member satisfaction. In addition to strategic oversight, this role will lead the development and execution of improvement strategies for Medicare Part C and D Stars, utilizing performance analytics to identify opportunities and assess the impact of quality improvement activities.

Key Accountabilities:

Strategic Leadership

• Develop and implement a comprehensive, multi-year quality management strategy aligned with the organization’s mission and objectives.
• Provide strategic oversight for organization-wide infrastructure to drive quality improvement, clinical quality enhancements and advance health equity.
• Champion member-centric, continuous improvement mindset and promote initiatives and tactics incorporating member experience and satisfaction.
  
  

Quality Program and Performance Management

• Oversee the performance of health plan quality programs, emphasizing continuous improvement and achievement of organizational goals.
• Optimize organizational quality governance structure to drive ongoing oversight and action related to the quality of care and service our members receive, including equitable care.
• Promote NCQA best practice framework across the organization ensuring achievement of applicable Health Plan and Health Equity accreditations.
• Oversee the provider credentialing program in compliance with accreditation and regulatory requirements.
• Drive data-informed development and implementation of annual work plan and program evaluations including innovative member and provider strategies to address member needs and drive improvement.
• Partner with data and analytics teams to ensure robust data acquisition strategies and reporting infrastructure to ensure ongoing, timely and accurate quality performance monitoring.
• Ensure accurate and timely quality reporting and submissions in compliance with regulatory and accreditation requirements and timelines.
• Represent health plan in external quality-related committees and industry forums and build strong relationships with accreditation organizations and other applicable regulatory agencies and stakeholders.
  
  

Stars

• Plan, develop, and implement effective improvement strategies to achieve high performance for Medicare Part C and D Stars.
• Lead and implement Medicare Stars-related measure performance analytics to identify areas of opportunity and assess the impact on quality improvement activities.
• Effectively lead and partner with cross-functional business units in planning and executing Stars improvement strategies and programs.
• Develop strategic direction, training, goals, and coaching plans for the Medicare Stars Team and cross-functional Medica Teams supporting Stars programs.
• Lead cross-functional teams to implement Medicare Stars measure level improvement interventions across all key categories of the Stars Program.
• Develop strong relationships with the Provider Network team to communicate new requirements and opportunities around clinical workflow and data reporting.
• Influence thought leadership regarding measure level improvement opportunities and serve as a subject matter expert in meetings and discussions.
• Collaborate with cross-functional teams to assure regular tracking of Stars program KPIs to inform timely follow-up and escalation of gaps and barriers.
• Establish policies that support morale and engagement, team member retention, staff development, and growth.
• Support the oversight of the department's operations to ensure compliance with all regulatory requirements.
  
  

Health Equity

• Advance Medica’s health equity strategy including key capabilities and capacity to increase Medica’s impact on improving health equity.
• Partner with data and analytics team to improve data completeness and analysis capabilities to identify disparities, opportunities for intervention and monitor progress.
• Champion health equity priorities and drive innovative solutions to address member needs.
• Represent health plan in external health equity committees and industry forums.
  
  

People and Talent Development

• Manage and develop Quality department and Stars staff, including hiring, training and performance management.
• Foster an engaging, innovative and inclusive work environment embracing continuous improvement and supporting teams through change and adoption of new initiatives.
• This role requires a strategic thinker with a passion for improving healthcare quality, Stars scores and member outcomes.
• The ideal candidate has a collaborative leadership style and will have a proven track record of implementing successful quality initiatives in a health plan setting and the ability to drive organizational change to achieve quality goals.
  
  

Qualifications:

• Bachelor’s degree or equivalent combination of education and work experience required, advance degree preferred.
• 10 years of applicable experience in healthcare, with at least 7 years in a progressive leadership roles required.
• Prior experience in driving and leading at least a 4-star Medicare or Medicare Advantage Stars Rating.
• Experience in achieving at least a 4 Star rating for Medicare Stars in a non-integrated healthcare setting.
  
  

Skills and Abilities:

• Strong understanding of healthcare industry trends, quality improvement methodologies and evolving landscape of healthcare quality metrics and methodology.
• Experience in quality leadership, HEDIS strategy, state Medicaid, NCQA accreditation and CMS Star ratings program.
• Proven ability to lead high-impact strategic initiatives, driving significant improvements in quality performance, health outcome and organizational alignment.
• Experience with health plan operations and applicable regulatory requirements.
• Demonstrated success in building and leading dynamic, high performing teams.
  
  

This position is an Office role, which requires an employee to work from the designated office, Minnetonka MN, on average, 3 times per week.

The full base pay salary range for this position is $224,000 - $336,000. Annual base pay salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and or licensures, the position’s scope and responsibility, internal pay equity and external market salary data.

In addition to base compensation, this position is eligible for Medica’s Short Term Incentive plan, Long Term Incentive plan and our Supplemental Executive Retirement Plan.

Medica offers a generous total rewards package that includes competitive medical, dental, vision, executive life insurance, Self-Managed Time Off, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica’s compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.