ABOUT US

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well.

Our Core Values are:

• We serve faithfully by doing what’s right with a joyful heart.
• We never settle by constantly striving for better.
• We are in it together by supporting one another and those we serve.
• We make an impact by taking initiative and delivering exceptional experience.

JOB SUMMARY

The Director of Quality for MA Stars will lead strategic initiatives to achieve and sustain exceptional Medicare Advantage Star Ratings performance across the health plan. This role is responsible for developing and executing quality improvement programs, collaborating with cross-functional teams, leading vendor partnerships, member satisfaction, and ensuring compliance with CMS and regulatory requirements. The ideal candidate will bring deep expertise in MA Stars, HEDIS, CAHPS, and HOS metrics, and a proven track record of driving measurable improvements in quality outcomes.

QUALIFICATIONS

• EDUCATION - Bachelor’s, Master’s preferred
• EXPERIENCE - 3 Years of Experience, 7 years preferred

Effectively educate and engage leadership on the short- and long-term implications of Stars performance, especially related to anticipated regulatory changes, industry trends, and the financial impact on quality bonus payments and member experience. Influence enterprise-level prioritization of initiatives critical to Stars success.

• Project Management: Drive execution of key Stars initiatives by applying structured project management methodologies, managing timelines, resources, and stakeholder engagement to ensure timely and effective delivery

• Strategic Leadership: Develop and execute strategies to meet and exceed Medicare Stars performance targets to achieve and maintain 4+ star ratings. Drive improvement in clinical quality metrics, with a focus on Rx adherence measures (statin use, hypertension medication adherence, etc.). Monitor regulatory updates and ensure compliance with CMS Star Ratings requirements.
• Clinical Metrics Management: Analyze performance data and trends for clinical metrics to identify improvement opportunities. Collaborate with clinical teams to develop and implement interventions to enhance outcomes. Lead efforts to optimize medication adherence programs and support pharmacy-related initiatives. Oversee performance tracking and analytics for HEDIS, CAHPS, HOS, and Part D measures.
• Monitor CMS updates and ensure compliance with regulatory requirements.
• Develop dashboards and reporting tools to communicate performance trends to executive leadership.
• Represent the organization in external quality forums and CMS-related engagements.
• Operational Excellence: Oversee daily operations related to quality initiatives, ensuring seamless execution and alignment with organizational goals. Develop processes to streamline workflows, enhance efficiency, and achieve measurable results. Foster a culture of continuous improvement and accountability across teams.
• Vendor Oversight: Manage relationships with external vendors, ensuring contractual obligations and quality deliverables are met. Evaluate vendor performance through established metrics and implement corrective actions when necessary. Serve as the primary liaison between vendors and internal stakeholders, promoting collaboration and alignment.
• Cross-Functional Collaboration: Partner with member experience, healthcare services, pharmacy, and IT teams to design and execute initiatives. Communicate performance outcomes and improvement plans to executive leadership and stakeholders. Lead or participate in workgroups to address system-wide challenges affecting Stars performance.
• Stakeholder Influence & Executive Engagement: Serve as a trusted advisor and thought leader to senior executives. Identify organizational gaps in resources, infrastructure, or capabilities that impact Stars performance. Build business cases for new or enhanced programs and interventions, supported by data-driven justification.

Effectively educate and engage leadership on the short- and long-term implications of Stars performance, especially related to anticipated regulatory changes, industry trends, and the financial impact on quality bonus payments and member experience. Influence enterprise-level prioritization of initiatives critical to Stars success.

• Project Management: Drive execution of key Stars initiatives by applying structured project management methodologies, managing timelines, resources, and stakeholder engagement to ensure timely and effective delivery.