Director, Stars

Arizona Priority Care (AZPC) is an Integrated Provider Network focused on providing whole-person care to Senior and Medicaid populations, through advanced value-based models. Our provider network is comprised of more than 6,000 health care providers, including primary and specialty care physicians, hospitals and ancillary providers. We have operated in the Arizona market for more than 14 years, based in Chandler, Arizona, and are an affiliate of Heritage Provider Network. As a leading value-based provider organization, we are committed to improving the quality of care, providing excellent member and provider experiences all while reducing cost.

The Director of Stars is responsible for the strategic direction, operational oversight, and continuous improvement of quality performance initiatives across the organization’s Medicare Advantage and other value-based care programs. Service as a subject matter expert and strategic partner, the Director oversees Medicare Advantage Star Ratings initiatives, HEDIS performance, clinical quality improvement, medical record collection and validation, provider education, member outreach, and performance analytics.

The Director of Stars collaborates with executive leadership, network providers, health plan partners, clinical operations, pharmacy, care management, information technology, and analytic teams to develop and implement strategies that close gaps in care, improve preventive screening, and chronic disease management, and achieve organizational quality objectives. This role translates regulatory requirements, measure specifications, and performance data into actional strategies to improve Star Ratings, enhance member experience, strengthens provider performance, and maximize value-based reimbursement.

POSITION DUTIES & RESPONSIBILITES

• Develop and maintain the organization’s annual quality improvement plan that directly impacts Star Ratings.
• Establish quality goals, performance indicators, improvement initiatives, and accountability standards.
• Align quality initiatives with value-based contracts, clinical priorities, and organizational objectives.
• Oversee applicable HEDIS measures, Medicare Advantage Stars initiatives, preventive care, chronic disease monitoring, and member experience improvement.
• Monitor quality performance across participating network providers and across health plans.
• Coordinate medical record collection and data validation for care gap closures.
• Implement targeted interventions to improve screening rates, diabetes care, blood pressure control, medication adherence, and care transitions.
• Conduct educational forums to network providers and internal leadership teams.
• Collaborate with care management, pharmacy, utilization management, and member services to collectively improve outcomes and reduce avoidable utilization.
• Oversee quality dashboards, performance reports, trend analysis, and executive reporting.
• Generate financial outcome reports for quality incentives based on performance targets.
• Support in the development of quality-related incentive programs and provider performance initiatives.
• Maintain oversight of CMS, NCQA, PQA, health plan, and contractual quality requirements.
• Support audit readiness, documentation validation, regulatory reviews, and corrective action plans.
• Partner with quality on the development and maintenance of member experience initiatives, including CAHPS and HOS survey tools.
• Other duties as assigned.

EDUCATION, TRAINING AND EXPERIENCE

• Bachelor’s degree or High School Diploma with five or more years of experience of healthcare quality, managed care, population health, HEDIS, or value-based care experience.
• Three or more years of leadership or supervisory experience.
• Experience working with IPAs, ACOs, medical groups, physician networks, or health plans.
• Knowledge of HEDIS, Medicare Advantage Stars, clinical quality improvement, population health, and provider performance reporting.
• Strong communication, leadership, project management, and relationship-building skills.
• Strong analytical skills.
• Ability to effectively interact at all levels of the organization.
• Current Arizona Driver’s license and proof of insurance.

*This role requires FT in-office presence for the first 60 days of employment. Hybrid schedule available after initial training period.*