Director, Stars HEDIS Improvement and Operations – Preventive Measures

Become a part of our caring community and help us put health first
 

Stars is an organization that is responsible for improving health outcomes and advancing the care experience of our members and provider partners through quality solutions. Stars is committed to caring for our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS).

The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures covering preventive care screenings, health condition management, health outcomes, patient experience, and plan operations.

The Director, Stars HEDIS Improvement and Operations is responsible for overseeing the implementation, management, and continuous improvement of the Healthcare Effectiveness Data and Information Set (HEDIS) initiatives as part of the CMS Stars Program. This role will develop and implement strategies to improve clinical quality and performance metrics.

Key Responsibilities:

• Serve as an internal expert on HEDIS Preventive Measures (currently BCS, COA, COL, OMW, DSF) technical specifications, regulatory changes, and CMS guidance

• Lead and be accountable for enterprise HEDIS performance by directing measure owners, synthesizing performance insights, and driving measurable improvement across all assigned measures

• Accelerate shared accountability for HEDIS improvement by clearly communicating Enterprise strategy, aligning stakeholders, and mobilizing action to deliver tangible results

• Develop and manage a strategic portfolio of improvement initiatives targeting key drivers of HEDIS performance and delivering measurable gains in clinical quality and health outcomes

• Collaborate with cross-functional teams to design, test, and scale interventions that drive measurable improvement in Star ratings

• Own initiative performance oversight and development of integrated operational reporting, providing regular executive-level insights and recommendations to Stars and executive leadership

• Lead analytics partners to develop robust, actionable reporting that prioritizes quality improvement and translates complex data into clear insights

• Develop strategic recommendations for program evolution and policy advocacy, including written summaries and talking points for engagement with CMS, industry groups, and internal stakeholders

• Oversee budget, vendor relationships and program delivery to ensure efficient execution and return on investment

• Lead and develop a team of high- performing direct reports of 7+ measure owners, fostering accountability, engagement, and sustained enterprise performance

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree

• 8+ years of experience in Medicare Advantage Stars and/or HEDIS, including accountability for enterprise-level quality performance and improvement strategy

• 5 years or more of people leadership experience, including leading high-performing teams

• Demonstrated experience leading complex, cross-functional operations in a Medicare Advantage or clinical quality environment

• Experience leading a portfolio of complex initiatives with a proven track record of delivering measurable performance improvement

• Experience driving enterprise strategy, including influencing senior leaders and aligning cross-functional stakeholders

• Demonstrated ability to lead effectively in fast-paced, high-accountability environments, managing competing priorities while maintaining focus on results

• Exceptional written and verbal communication skills, including the ability to present complex information clearly and confidently to executive audiences Proven ability to influence without authority and a track record of success leading through ambiguity Ability to interpret and leverage data and analytics to improve strategy and make recommendations

Desired Qualifications

• Masters degree (MPH, MBA, MHA, or equivalent) preferred

• Demonstrated subject-matter expertise in Medicare Advantage Stars, with deep ownership of HEDIS Preventive Measures performance and accountability for enterprise-level outcomes

Additional Information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

 

$150,000 - $206,300 per year

 

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

Application Deadline: 04-20-2026

About us
 

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.