California Licensed Director of Health Quality

Job Summary

A company is looking for a Director of Health Plan Quality (RN).

Key Responsibilities

• Lead enterprise STAR strategy to achieve and sustain 4+ STAR ratings while overseeing HEDIS, HOS, and administrative measure performance
• Drive improvements in member experience and satisfaction through CAHPS strategy and data analysis
• Provide clinical oversight of Appeals and Grievances processes to enhance member-centric resolution experiences

Required Qualifications, Training, and Education

• Bachelor's degree required; Master's preferred (MSN, MPH, MHA, MBA)
• Active, unrestricted Registered Nurse (RN) license in any US state is required; CA RN license preferred
• 4+ years in health plan quality leadership and 5+ years in senior leadership roles
• Minimum of 3 years of clinical experience
• Deep experience across STAR ratings and CAHPS is required