Vice President, Quality, Stars, Risk Adjustment and Performance Operations

Job Description

Job Description

Position: Vice President, Quality, Stars, Risk Adjustment and Performance Operations

The Vice President, Quality, Stars, Risk Adjustment, and Performance Operations will lead Monogram Health’s enterprise strategy and operational execution across all products, with an emphasis on Medicare Advantage, Quality Stars, HEDIS, Risk Adjustment, Clinical Documentation Improvement, and compliance standards. This role will collaborate across departments to translate strategy into scalable workflows, clear accountability, and measurable performance results.

• Lead Monogram Health’s enterprise strategy and end-to-end performance for Quality, Stars, HEDIS, Risk Adjustment, and clinical documentation improvement.
• Set annual and long-range goals, operating plans, milestones, and accountability, and drive execution and corrective action across the organization.
• Develop payer specific strategies that reflect contractual requirements, performance methodologies, financial incentives, data availability, and operational opportunities.
• Own trusted scorecards, forecasts, and reporting with clear definitions, validated data, and reconciliation across clinical, payer, CMS, and financial sources.
• Partner with Finance, Actuarial, and Medical Economics to quantify and forecast the revenue, medical cost, and margin implications of performance.
• Translate opportunities into scalable clinical and operational workflows by defining requirements and priorities for clinical, product, analytics, and technology teams.
• Lead governance and executive reviews, remove barriers, resolve competing priorities, and hold internal teams and external partners accountable for results.
• Manage payer relationships and external partners, including data and methodology issues, contractual discussions, implementation, service levels, and measurable return on investment.
• Oversee coding, clinical documentation integrity, audit, and data submission controls, ensuring regulatory compliance, audit readiness, remediation, and effective feedback loops.
• Build and retain a high performing multidisciplinary team and educate stakeholders on regulatory, Stars, HEDIS, and risk model changes and their operational and financial implications.

• Bachelor’s degree required; master’s degree in healthcare, business, public health, or a related field preferred.
• Minimum of ten (10) years of progressive healthcare leadership experience, including at least five (5) years leading Medicare Advantage Stars, Quality, HEDIS, Risk Adjustment, or closely related programs.
• Demonstrated ability to build and lead professional and large-scale operational teams in a fast paced, matrixed environment.
• Advanced analytical and financial skills, including the ability to translate payer, CMS, clinical, and financial data into executive decisions and measurable results.
• Experience with Medicare Advantage payer relationships, value-based contracts, Stars incentives, risk adjustment economics, coding, audit, and performance methodology issues.
• Proven ability to define requirements and drive delivery across clinical, operational, analytics, technology, actuarial, finance, payer, and vendor teams without direct authority over every resource.

The base salary range for this role is $210,000 to $280,000 and reflects the range of experience and qualifications we may consider. Final compensation will be determined based on geographic location and job-related factors such as experience, skills, education, certifications, and internal compensation considerations. While a larger range is posted, most offers will typically fall within a narrower band based on these factors.

In addition to base salary, this role is eligible for additional compensation, including bonus opportunities and a comprehensive benefits package.

• Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts
• Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources
• Time Off & Leave – 20 PTO days, 7 paid holidays, and 1 floating day to make your own, and paid parental leave
• Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts

Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.  

Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home. 

Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.