Director, HEDIS Performance & Strategy (Enterprise Medicare) - REMOTE

Job Description

The Director, HEDIS Performance & Strategy leads the execution of enterprise initiatives to improve HEDIS measures aligned with Medicare Star Ratings. As a strategic partner to senior quality leadership, this role translates priorities into coordinated workstreams across markets and shared services, aligning operations, supplemental data, reporting, provider engagement, and quality improvement.

The ideal candidate brings deep expertise in HEDIS operations, Medicare Stars, supplemental data, and measure implementation, with the ability to analyze performance, influence matrixed stakeholders, and drive accountability.

Primary Responsibilities

Strategic Deployment & Operational Execution

• Lead enterprise execution of Medicare HEDIS and Stars strategies by translating quality priorities into actionable measure-level workstreams.
• Coordinate enterprise readiness planning for upcoming NCQA, CMS, HEDIS, and Stars measure changes.
• Drive implementation of operational, documentation, coding, workflow, and supplemental data enhancements aligned to measure requirements.

Cross-Functional Leadership & Alignment

• Align Quality, Care Management, Pharmacy, Network, Provider Engagement, Analytics, IT, Supplemental Data, and market stakeholders around enterprise priorities, execution, and accountability.

Measure Performance Optimization

• Analyze measure gaps, performance trends, supplemental data impact, chase outcomes, and intervention effectiveness to prioritize improvement opportunities.
• Proactively identify performance risks and operational barriers, recommend remediation, and monitor improvement initiatives for Stars-aligned measures.

Supplemental Data & HEDIS Operations

• Assess opportunities for evaluation, integration, mapping, validation, and optimization of supplemental data sources in partnership with Systems and technical teams.
• Ensure documentation workflows and source systems support data integrity, audit readiness, measure capture, and HEDIS reporting accuracy.

Program & Project Management

• Maintain enterprise workplans, timelines, risks, dependencies, decisions, and progress reporting while driving stakeholder accountability and continuous improvement.

Executive Support & Communication

• Develop executive materials, performance analyses, prioritization recommendations, and implementation updates for leadership and governance forums.

Required Qualifications

• Deep expertise in HEDIS specifications, Medicare Star Ratings, supplemental data, and enterprise quality operations.
• Demonstrated success leading complex, cross-functional Medicare quality initiatives and operational workstreams in matrixed organizations.
• Strong analytical skills with experience interpreting performance data and operational impacts.
• Excellent relationship management and communication skills.
• Lean Six Sigma Black Belt preferred certification.
• DSNP experience preferred.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Originally posted on Himalayas