VP Enterprise Medicare Stars Programs

This role will be responsible for building and leading an integrated enterprise performance engine that delivers top quartile results in CMS Stars, Quality, HEDIS, and CAHPS, for growing a Medicare Advantage product segment. The successful candidate will unify and deploy best in class execution across historically siloed functions under a single operating model aligned to clinical governance and enterprise performance., * Develop and implement a unified operating model across Quality, Stars, HEDIS, CAHPS, and analytics.

• Establish operating model for clinical documentation integrity and population health.
• Serve as the executive owner of Stars bonus revenue
• Align Quality, Stars, and Risk Adjustment under clinical governance and the CMO.
• Collaborate with business area P&L leaders, CFO, Network, Pharmacy, and Operations to drive cross-functional improvement and execution
• Lead the enterprise Stars strategy, forecasting, and execution model.
• Oversee the Stars Command Center with weekly performance monitoring and escalation.
• Ensure all measures have clear owners, intervention plans, KPIs, and 30-60-90 day execution plans.
• Drive provider behavior change through aligned incentives, scorecards, and targeted interventions.
• Oversee all HEDIS operations, hybrid strategy, supplemental data, and provider documentation improvement.
• Lead CAHPS strategy, including member experience, access, complaints, appeals, and grievance reduction.
• Develop best-in-class intervention playbooks for each measure.
• Ensure alignment with clinical quality, care management, and population health.
• Serve as the executive owner of the enterprise vendor ecosystem supporting Quality, Stars, HEDIS, and CAHPS.
• Consolidate vendors to reduce cost, improve quality, and strengthen audit defensibility.
• Lead enterprise analytics for Stars, HEDIS, CAHPS.
• Oversee forecasting for Stars bonus revenue accuracy.
• Ensure compliance with CMS, NCQA, URAC, and regulatory requirements.
• Lead enterprise audit readiness for Stars, and HEDIS.

• 10+ years of leadership experience in Medicare Advantage Quality, Stars, HEDIS, and CAHPS.
• Proven track record of driving a plan to strong Star performance.
• Deep knowledge of CMS Stars methodology, HEDIS technical specs, and CAHPS.
• Experience leading large cross-functional teams and complex vendor ecosystems.
• High proficiency in driving performance and execution.
• Strong financial acumen, including forecasting, ROI analysis, and budget management.
• Enterprise thinker with ability to unify historically siloed functions.
• Strong operator with a bias for execution and measurable outcomes and bias towards urgency.
• Exceptional communicator with ability to influence at all levels.
• Data-driven decision maker with strong analytical orientation.
• Builder of high-performing teams and scalable operating models.

Preferred:

• Master’s degree in healthcare administration, public health, business, or related field.

General Physical Demands: Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan including employer match;
• Paid time off, volunteer time off, 10 holidays and 2 well-being days;
• Additional voluntary benefits available; and
• A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.