Director, Market Quality Improvement(Medicare STARS Leadership Experience Required)

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Director, Market Quality Improvement (Medicare STARS Leadership Experience Required) based in United States.

This is a senior leadership opportunity focused on driving quality strategy, performance, and regulatory excellence across highly regulated healthcare programs.

The role leads initiatives designed to improve member experience, provider performance, clinical quality, and operational outcomes.

You will oversee quality metrics, identify performance gaps, and guide corrective actions and improvement programs.

The position partners closely with clinical, analytics, compliance, legal, network, and medical management teams.

You will translate evolving CMS, state, and contractual requirements into practical execution and readiness strategies.

Strong executive presence and experience leading Medicare or other government-sponsored healthcare programs are essential.

This is an influential role for a strategic, data-driven leader who can deliver measurable results in a complex, matrixed environment.

Accountabilities

• Lead the execution of quality strategy across assigned lines of business, ensuring alignment with contractual obligations, regulatory requirements, and enterprise quality objectives.
• Oversee quality and performance measures covering access to care, clinical quality, beneficiary experience, network adequacy, utilization, and operational performance.
• Monitor performance against contractual and regulatory standards, identify emerging risks and gaps, and implement corrective action plans where necessary.
• Lead quality improvement initiatives, performance interventions, and monitoring activities across clinical, operational, and provider-facing functions.
• Partner with Compliance, Legal, Internal Audit, and other stakeholders to maintain regulatory readiness, support audits, and address external findings.
• Collaborate with Analytics to develop dashboards, reporting, and actionable insights that support quality oversight and data-driven decision-making.
• Support provider engagement around quality requirements, performance expectations, documentation, access standards, and improvement initiatives.
• Coordinate with Medical Management and Network teams to align utilization management, care coordination, and network performance with established quality standards.
• Lead governance meetings, workgroups, and operational forums focused on quality performance, compliance, and organizational readiness.
• Ensure teams receive appropriate training and education on quality program requirements, policies, and operational processes.
• Track changes to CMS and state guidance, regulations, and contracts, translating them into actionable quality and operational plans.
• Serve as a senior subject matter expert on quality programs and represent the organization in leadership discussions and external engagements when required.

Requirements

• Bachelor’s degree in Healthcare Administration, Business, Public Health, or a related field; equivalent relevant experience may be considered in lieu of education.
• Master’s degree in Healthcare Administration, Business, or a related discipline is preferred.
• At least 7 years of experience in managed care, government-sponsored healthcare programs, or healthcare operations.
• At least 3 years of experience leading Medicare, Medicaid, or other highly regulated government healthcare programs, with Medicare STARS leadership experience strongly required for this role.
• Demonstrated experience with healthcare regulatory compliance, audits, contractual performance management, or accreditation readiness.
• Previous people-management or matrixed leadership experience.
• Strong knowledge of CMS and state quality program requirements, government healthcare contracting, and regulatory oversight.
• Demonstrated ability to manage quality measures, performance metrics, and operational outcomes and turn data into actionable improvement strategies.
• Strong analytical, problem-solving, planning, and prioritization skills.
• Excellent communication and stakeholder-management capabilities, including the ability to influence clinical, operational, provider, and executive audiences.
• Ability to lead effectively within complex, cross-functional, matrixed environments.
• High degree of professionalism, accountability, sound judgment, and ownership.
• Proficiency with Microsoft Excel, Word, PowerPoint, and data visualization tools.
• Ability to travel occasionally, up to approximately 15%, based on business needs.

Benefits

• Annual salary range of $113,000-$197,700, depending on qualifications, experience, education, training, role scope, and other relevant factors.
• Potential eligibility for a bonus tied to individual and organizational performance.
• Comprehensive total rewards package focused on employee well-being.
• Opportunities to lead high-impact quality transformation initiatives within government-sponsored healthcare.
• Collaborative, cross-functional working environment with exposure to senior leadership.
• Professional development and opportunities to build expertise in healthcare quality, regulatory compliance, and performance improvement.
• Inclusive workplace committed to belonging and supporting individuals from diverse backgrounds.