Director, HEDIS and Quality Performance

Demonstrated expertise in ECDS reporting, clinical data acquisition and interoperability (including FHIR and standardized clinical terminology), and the transition from hybrid to digital quality measurement.

Advanced knowledge of HEDIS methodology, NCQA requirements, CMS Star Ratings, supplemental data, and measure specifications.

Minimum 7 years of progressively responsible experience leading HEDIS strategy and improvement in a health plan, with measurable results on measures contributing to Medicare Advantage Star Ratings.

Demonstrated SME depth in medical record retrieval, abstraction, over-read, validation, and audit readiness.

Preferred Qualifications

Experience at a consistently high-performing Medicare Advantage plan, including 4+ or 5-Star organizations, across HMO, PPO, and/or D-SNP products.

Experience integrating HEDIS strategy with CAHPS, medication adherence, provider performance, and risk adjustment.

Experience with HEDIS vendors, NCQA-certified auditors, quality technology platforms, and EHR/clinical data exchange.

Lean, Six Sigma, or related quality improvement certification; experience presenting to C-suite or Board-level committees.

Master’s degree in healthcare administration, public health, nursing, health sciences, business, health informatics, or related field.

While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds.

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.