California Licensed Director of Health Quality

Job Summary

To drive an integrated strategy for optimizing clinical quality and member outcomes, the full-time California Licensed Director of Health Quality will lead initiatives focused on STAR Ratings, Member Experience, and Risk Adjustment while overseeing Appeals and Grievances in a fully remote setting.

Key responsibilities

• Lead enterprise STAR strategy to achieve and sustain 4+ STAR ratings while overseeing HEDIS and administrative measure performance
• Drive improvements in member experience and satisfaction through collaboration with marketing and customer service teams
• Provide clinical oversight of Appeals and Grievances processes, ensuring a seamless resolution experience for members

Required qualifications

• Active, unrestricted Registered Nurse (RN) license in any US state; California RN license preferred
• Bachelor's degree required; Master's degree (MSN, MPH, MHA, MBA) preferred
• 4+ years in health plan quality leadership and 5+ years in senior leadership roles
• Deep experience across STAR ratings and CAHPS required
• Certified Professional in Healthcare Quality (CPHQ) or Certified Risk Adjustment Coder (CRC) preferred