Director, Clinical HEDIS Strategy

Accountable for the oversight and continuous strategic improvement of Medica’s clinical HEDIS program. The Director of Clinical HEDIS Strategy drives organizational excellence by leading high-level strategy development, fostering innovation in clinical processes and building a robust, data-driven framework for performance improvement. This position is part of Medica’s quality leadership team and will collaborate with leaders and teams across quality improvement and quality submission to drive clinical quality improvement and achieve organizational objectives. Key Accountabilities Strategic Leadership Establish and communicate a long-term vision for Medica’s clinical HEDIS strategy, aligning it with broader organizational objectives and industry advancements. Drive innovative solutions to enhance health data connectivity and clinical review practices, emphasizing continuous improvement. Remain abreast of emerging industry trends and lead cross-functional teams to implement initiatives to drive end to end HEDIS improvements. Clinical Review Deliver highly effective clinical HEDIS infrastructure and operating model to achieve organizational quality goals. Ensure clinical HEDIS operating model delivers processes and outputs in compliance with NCQA and CMS Medicare Star requirements and other applicable audit requirements. Oversee the execution of government audits requiring medical record reviews for other regulatory audits, as applicable. Data-Driven Quality Performance & Improvement Develop and implement a comprehensive, proactive business framework for monitoring and enhancing quality performance, embedding data at the core of decision making. Develop and implement business standards and toolsets for evaluating progress and impact of the quality program and individual quality initiatives. Generate data-driven insights and actions to inform quality improvement strategies. Lead cross-functional initiatives to ensure clinical activities and related data and documentation processes are completely and accurately represented in public quality ratings. Partner with data and analytics to deliver ongoing, timely and accurate metric reporting on all quality metrics and initiatives, including HEIDS and Stars. Collaborate with cross-functional teams to identify emerging trends, align strategic initiatives to intended impact and outcomes, and promote integration across the organization-wide quality program. Promote cross-team collaboration and coordination for data-driven HEDIS processes, ensuring processes efficiently and effectively meet requirements and drive performance. People and Talent Development Support team development through coaching, skills enhancement and career development opportunities. Foster an engaging, innovative and inclusive work environment embracing continuous improvement and supporting teams through change and adoption of new initiatives. Define and nurture a collaborative and partnership-oriented culture among direct team and cross-functional relationships. Minimum Qualifications Bachelor’s degree or equivalent combination of education and work experience. 10+ years of related work experience within healthcare. Progressive leadership experience. Skills and Abilities Extensive experience in health plan quality, CMS Stars and HEDIS operations and strategy. Expertise in healthcare data practices and integrating data-driven insights into actionable strategies. Proven ability to lead high-impact strategic initiatives, driving significant improvements in quality performance and organizational alignment. Strong understanding of industry trends, regulatory requirements, and the evolving landscape of healthcare quality metrics. This position is a Remote role and will work remotely 100% of the time. To be eligible for consideration, candidates must have a primary home address located within any state where Medica is registered as an employer - AR, AZ, FL, GA, IA, IL, KS, KY, MD, ME, MI, MN, MO, ND, NE, OK, SD, TN, TX, VA, WI. The full salary range for this position is $108,400 - $185,900. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees. Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

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