Director, Market Quality Improvement – Medicare STARS Leadership Experience Required

Job not on LinkedIn

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $113k - $197.7k / year

⏰ Full Time

🟠 Senior

👔 Director

🦅 H1B Visa Sponsor

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Lead execution of CareSource’s quality strategy for assigned Lines of Business • Oversee quality and performance metrics, including access to care, clinical quality, beneficiary experience, network adequacy, utilization, and operational performance indicators • Monitor program performance against contractual standards, identifying risks, trends, and gaps • Implement corrective action plans as needed • Partner with Compliance, Legal, and Internal Audit on regulatory readiness, audit preparedness, and responses to CMS, state/regulatory agencies, and external audit findings • Direct and support quality improvement initiatives, performance interventions, and monitoring across clinical, operational, and provider-facing domains • Collaborate with Analytics on dashboards, reporting, and performance insights • Support provider engagement strategies related to quality improvement, performance expectations, documentation, access standards, and quality initiatives • Coordinate with Medical Management and Network teams on utilization management, care coordination, and network performance • Lead governance routines, workgroups, and operational forums focused on quality performance, compliance, and readiness • Ensure staff training, education, and awareness regarding quality program requirements and operational processes • Track regulatory changes, contract modifications, and CMS/State guidance, translating requirements into operational and quality execution plans • Serve as a subject matter expert for quality programs in internal leadership discussions and external engagements • Perform other job-related duties as requested

🎯 Requirements

• Bachelor's degree in Healthcare Administration, Business, Public Health, or related field required • Equivalent years of relevant work experience may be accepted in lieu of required education • Seven (7) years of experience in managed care, government-sponsored healthcare programs, or healthcare operations required • Three (3) years of experience leading Medicare, Medicaid, or other highly regulated government healthcare programs required • Experience with regulatory compliance, audits, contractual performance management, or accreditation readiness required • Prior people management or matrixed leadership experience required • Strong knowledge of quality program requirements, CMS/State oversight, and government healthcare contracting • Experience with healthcare regulatory compliance, audit readiness, and corrective action planning • Demonstrated ability to manage performance metrics, quality measures, and operational outcomes • Strong analytical and problem-solving skills with ability to translate data into actionable insights • Excellent communication and stakeholder management skills across clinical, operational, and executive audiences • Ability to lead and influence in a matrixed, cross-functional environment • Strong organizational, planning, and prioritization skills • High level of professionalism, judgment, and accountability • Proficiency in Microsoft Excel, Word, PowerPoint, and data visualization tools • No licensure or certification required

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Employee total well-being support • Remote work arrangement • Up to 15% occasional travel based on department needs