New

Director of Stars Strategy

Neighborhood Health Plan of Rhode Island

United States, Rhode Island, Smithfield

910 Douglas Pike (Show on map)

Jun 27, 2025

Job Details

Job Location		Smithfield, RI - Smithfield, RI
Position Type		Full Time
Education Level		Bachelors Degree

Travel Percentage		Occasional
Job Shift		Daytime
Job Category		Management

Description

The Director of Stars Strategy will lead and drive the strategic development, implementation, and oversight of initiatives aimed at optimizing Neighborhood's clinical outcomes and achieving 5-star ratings in Neighborhood's Medicaid and Medicare special needs plan lines of business and for the Medicaid Stars quality program. The Director will design, implement and manage all Stars related function to improve and sustain Stars performance. This role will focus on aligning organizational goals with CMS, Medicare and Medicaid Star Ratings requirements, engaging internal and external stakeholders in designing and communicating strategies and outcomes to leaders throughout the organization. The Director will be the subject matter expert (SME) and utilize dashboards to measure program effectiveness. The Director will work closely with Analytics to foster data sharing across all categories of measures by translating data into actionable and measurable strategies to improve performance, outcomes and compliance.

Duties and Responsibilities:
Responsibilities include, but are not limited to, the following:

Develop and manage a multiyear roadmap for Star ratings improvement for all Medicare contracts and Medicaid line of business. Translate business strategy into actionable business requirements.
Provide strategic direction for the Quality and Stars program, focusing on achieving and maintaining a 5-star rating by implementing robust quality improvement frameworks.
Ensure alignment with the organization's short- and long-term goals for performance improvement and Quality.
Establish clear performance goals and metrics for all Star rating and quality measures. Provide oversight of the measurement, tracking, and reporting of key quality performance indicators (Part C and Part D) to ensure alignment with CMS regulations and organizational goals.
Develop and maintain performance dashboards to report, monitor and optimize performance.
Ensure integration of Star ratings strategy with organizational objectives. Partner with clinical, operational, and network teams to develop action plans for addressing gaps in care, improving patient experience, and ensuring compliance with CMS Star measures.
Collaborate with contracting and provider relations to engage providers in network quality. Engage providers and internal stakeholders in value-based strategy design and implementation.
Lead root cause analysis for underperforming measures using industry standard methodologies. Utilize health care data analytics to assess performance trends, identify opportunities for improvement, and develop targeted interventions that enhance member care and outcomes.
Lead process improvement efforts across multiple departments, ensuring initiatives align with organizational objectives for clinical quality, patient safety, and regulatory compliance.
Manage and mentor a team for Stars performance, ensuring continuous development of skills, knowledge, and leadership abilities within the team.
Cultivate cross-functional relationships with senior leadership, external stakeholders, and regulatory bodies to ensure effective coordination and implementation of quality initiatives.
Acts as the CMS Star Measure and Program subject matter expert, advising on quality improvement initiatives and educating across the enterprise.
Provides influence and consultation in the development of the business strategy.
Provides best practices, drive innovation and promote a culture of quality across the organization.
Build organizational capacity and prepares high potentials for growth opportunities and advancement; builds collaborative networks inside and outside the organization for self and others.
Provide framework for soliciting and acting on performance feedback; drives collaboration to set goals and provide open feedback and coaching to foster performance improvement.
Model and drive continuous learning and oversee the recruitment, selection, and development of talent; stay current with industry trends, benchmarks, and best practices; ensures performance management guidelines and expectations to achieve business needs.
Act as a thought leader on industry trends, benchmarks, and best practices; shares best practices within and across teams to drive improvement.
Motivate and empower teams; maintains a highly skilled and engaged workforce by aligning cross-functional resource plans with business objectives.
Provide guidance when difficult decisions need to be made; creates opportunities for expanded scope of decision making and impact across teams.

Qualifications

Qualifications:

Required:

Bachelor's degree in business administration, health care administration, nursing, public health, or related field. Master's degree or PhD preferred.
Minimum of seven (7) years of experience in healthcare quality assurance/improvement
Proven years of leadership experience in quality improvement, with a focus on Medicare Advantage and DSNP, including direct oversight of Stars rating performance and regulatory submission
Proven experience managing large-scale quality improvement projects and operational budgets.
Experience with Medicare Stars, including HEDIS, CAHPS, HOS, Pharmacy and Administrative measures.
Expertise in CMS star rating methodologies, HEDIS, CAHPS, and regulatory compliance.
Must have demonstrated experience working in a matrixed or cross-functional teams
Proven ability to lead cross-functional teams, influence stakeholders, and drive organizational quality strategies to success.
Demonstrated success in driving organizational change and achieving measurable quality improvements.
Must be detailed oriented, able to work independently in a flexible environment, and able to manage multiple projects in an efficient, timely manner
Proficiency with computer information systems, software, and data-mining
Knowledge of State and Federal Health Care Regulations
Knowledge of clinical quality improvement methodologies, evidence-based practices, and regulatory requirements.
Strong proficiency in health care data analysis and quality metrics reporting, with the ability to translate data insights into actionable strategies.
Expertise in project management, including performance measurement, risk management, and process optimization.
Excellent communication skills, capable of presenting complex information to technical and non-technical audiences, including senior and executive management.
Regulatory and Compliance Acumen: Thorough understanding of CMS regulations, quality standards, and audit processes
Drive the integration of new technologies and innovative methods for process improvement, with a focus on member satisfaction, care access, and clinical outcomes.

Preferred:

Master's degree in Nursing; Healthcare Administration, Business Administration, Public Health or equivalent or PhD

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.