Job Description

Manager, Stars and Quality Improvement Programs - Remote

The Manager, Stars and Quality Improvement Programs is responsible for leading and managing the Medicare Advantage quality improvement program. This includes oversight of regulatory and accreditation requirements (CMS, NCQA, HEDIS, MIPS), quality reporting, audit readiness, and performance improvement initiatives aimed at enhancing member outcomes and provider engagement.

What You'll Be Doing

• Leading and managing all quality initiatives for the Medicare Advantage line of business, with a strong focus on CMS Star Ratings, HEDIS, CAHPS, and HOS performance and driving measurable improvements in medication adherence.
• Coordinating and overseeing annual HEDIS reporting and audits, including roadmap development, data validation, vendor coordination, analysis, and NCQA submission with particular attention to medication-related measures (e.g., adherence for diabetes, hypertension, and cholesterol).
• Supervising the MIPS submission process (where applicable to affiliated provider networks), ensuring data integrity and timely reporting.
• Managing quality dashboard reporting (HEDIS, Stars, and other metrics) to support internal strategy and value-based contracting efforts.
• Ensuring CMS audit readiness, leading efforts in data validation, monitoring, documentation, and corrective action plans.
• Designing and implementing targeted interventions to improve adherence, reduce readmissions, and close care gaps.
• Managing and mentoring the Quality and Performance Improvement team, including staff development, performance management, and ongoing training.
• Collaborating across clinical, operational, analytics, compliance, and provider teams to identify gaps and drive evidence-based quality improvements.
• Developing member and provider education materials to support performance on key quality measures.
• Serving as a subject matter expert on CMS, NCQA, HEDIS, and other regulatory and accreditation standards.
• Leading the creation and maintenance of quality policies and procedures; participating in policy committee meetings as needed.
• Preparing and presenting executive-level reports and updates to leadership, steering committees, and regulatory bodies.
• Oversee vendor relationships for data abstraction, reporting platforms, and engagement tools.
• Supporting departmental operations including budget oversight, resource planning, and contract alignment.
• Partnering with the QI Director on team structure, new client onboarding, staffing, and implementation strategies.
• Demonstrating strong communication, leadership, and problem-solving skills in a fast-paced, evolving healthcare environment.
• Leveraging quality incentive structures to identify high-impact opportunities and drive outcomes in the Medicare Advantage population.

What You'll Need To Have

• Bachelor's degree in nursing, Public Health, Healthcare Administration, or related field (master's preferred).
• Minimum 7 years of experience in healthcare quality improvement, preferably within managed care or Medicare Advantage.
• Strong knowledge of HEDIS, MIPS, NCQA, CMS Star Ratings, and related quality programs.
• Hands-on experience leading the HEDIS audit process, including collaboration with vendors, oversight of abstraction, and adherence to NCQA audit standards.
• Experience in data-driven quality initiatives, quality measure analysis, and performance improvement planning.
• Demonstrated success in managing cross-functional teams and leading complex quality projects.
• Proven ability to build, coach, and manage a high-performing team.
• Exceptional communication, leadership, and organizational skills.

What We Would Love For You To Have

• Certification in healthcare quality (e.g., CPHQ).
• Experience developing provider performance incentives or value-based care models.
• Familiarity with Population Health Management and Social Determinants of Health (SDoH) strategies.
• Experience with member engagement programs to boost CAHPS and HEDIS scores.
• Knowledge of predictive analytics and risk stratification to target population health interventions.
• A track record of leading cross-functional teams to meet or exceed Star Rating goals.

The base pay range for this role is between $87,000.00 and $90,000.00 per year.

ALIVE with Purpose: How We Thrive at Guidehealth

At Guidehealth, our values come to life in everything we do.

• We are Driven by Accountability grounded in transparency, reliability, and integrity as we navigate challenges and opportunities alike.
• Always Growing, Always Learning staying curious and continuously improving inspires us to shape a better future for healthcare.
• With Collaborative Innovation, we solve problems creatively, making every experience better for our employees and the patients we serve.
• At Guidehealth, Every Voice Matters we believe our collective strength is rooted in the unique perspectives of each team member.
• And through Empathy in Action, we build stronger connections with those who count on us.
• This is what it means to be ALIVE with purpose. This is how we thrive together at Guidehealth.

Benefits

All full-time employees of Guidehealth who work 30 hours per week or more are eligible for our comprehensive benefits package. While you are hard at work advancing value-based healthcare, we are here to ensure YOU have the care you and your family need and the opportunities for growth and development. Our commitments to you include:

• Work from Home: Guidehealth is a fully remote company, providing you the flexibility to spend less time commuting and more time focusing on your professional goals and personal needs.
• Keep Health a Priority: We offer comprehensive Medical, Dental, and Vision plans to keep you covered.
• Plan for the Future: Our 401(k) plan includes a 3% employer match to your 6% contribution.
• Have Peace of Mind: We provide Life and Disability insurance for those "just in case" moments. Additionally, we offer voluntary Life options to keep you and your loved ones protected.
• Feel Supported When You Need It Most: Our Employee Assistance Program (EAP) is here to help you through tough times.
• Take Time for Yourself: We offer paid time off plans helping you achieve work-life balance and meet your personal goals.
• Support Your New Family: Welcoming a new family member takes time and commitment. Guidehealth offers paid parental leave to give you the time you need.
• Learn and Grow: Your professional growth is important to us. Guidehealth offers various resources dedicated to your learning and development to advance your career with us.

Compensation

The listed compensation range listed is paid bi-weekly per our standard payroll practices. Final base pay decisions are dependent upon a variety of factors which may include, but are not limited to: skill set, years of relevant experience, education, location, and licensure/certifications.

Our Commitment to Equal Opportunity Employment

Diversity, inclusion, and belonging are at the core of Guidehealth's values. We are an equal opportunity employer. We enthusiastically accept our responsibility to make employment decisions without regard to race, religious creed, color, age, sex, sexual orientation and identity, national origin, citizenship, religion, marital status, familial status, physical, sensory, or medical disability, Family and Medical Leave, military or veteran status, pregnancy, childbirth or other related medical conditions, or any other classification protected by federal, state, and local laws and ordinances. Our management is fully dedicated to ensuring the fulfillment of this policy with respect to hiring, placement, promotion, transfer, demotion, layoff, termination, recruitment advertising, pay, and other forms of compensation, training, and general treatment during employment.

Our Commitment to Protection of Patient and Company Data

This position is responsible for following all Security policies and procedures in order to protect all PHI and PII under Guidehealth's custodianship as well as Guidehealth Intellectual Properties. For any security-specific roles, the responsibilities would be further defined by the hiring manager.

Remote Work Technical Requirements

Guidehealth is a fully remote company. We provide new employees with the necessary equipment to function in their role at no charge to the employee. Employees provide their own internet connection, capable of conducting video calls on camera and connecting to various internal and external systems. The required internet speed is a minimum of 50 mbps download, 10 mbps upload. Please consult with your internet provider or run a speed test to confirm your internet connection meets these requirements.

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