Senior Director, Quality Ratings & Network Performance

Senior Director, Quality Ratings & Network Performance

About the Company

Established organization assisting migrants with health insurance

Industry
Insurance

Type
Privately Held

Founded
1992

Employees
501-1000

Categories

• Insurance
• Health Insurance
• Health Care
• Non-Profit & Philanthropy
• Nonprofit Support
• Community Health
• Healthcare
• Health
• Finance

Specialties

• health insurance
• managed care services
• medical management
• medicare
• and medicaid

About the Role

The Company is seeking a Senior Director for Quality Ratings and Network Performance. The successful candidate will be responsible for leading strategic initiatives to enhance health plan quality ratings and provider performance, with a specific focus on Medicaid, Exchange, and D-SNP populations. This role requires a deep expertise in Medicaid and Medicare quality programs, including HEDIS, HOS, STAR, and CAHPS, and a proven track record in driving measurable improvements in these areas. The Senior Director will also be tasked with ensuring compliance with state and federal regulatory requirements, and will play a key role in the execution of provider strategies to improve quality outcomes. Key functions of the role include quality ratings oversight, organization star program management, and provider network performance. The ideal candidate will have a Bachelor's degree in a related field, with a Master's degree highly preferred, and at least 10 years of experience in healthcare quality, performance improvement, or healthcare analytics. A minimum of 7 years of progressive leadership experience is also required. The role demands a leader with strong analytical, communication, and strategic planning skills, who can effectively manage cross-functional teams and complex initiatives. The Senior Director will be expected to foster a culture of accountability, innovation, and continuous improvement, and to collaborate with internal and external stakeholders to ensure the integration of quality measurement initiatives throughout the organization.

Hiring Manager Title
Senior VP, Health Services

Travel Percent
Less than 10%

Functions

• Medical Care/Hospital Administration
• Data Management/Analytics