Job Description
The Director, HEDIS Performance & Strategy leads the execution of enterprise initiatives to improve HEDIS measures aligned with Medicare Star Ratings. As a strategic partner to senior quality leadership, this role translates priorities into coordinated workstreams across markets and shared services, aligning operations, supplemental data, reporting, provider engagement, and quality improvement.
The ideal candidate brings deep expertise in HEDIS operations, Medicare Stars, supplemental data, and measure implementation, with the ability to analyze performance, influence matrixed stakeholders, and drive accountability.
Primary Responsibilities
Strategic Deployment & Operational Execution
Lead enterprise execution of Medicare HEDIS and Stars strategies by translating quality priorities into actionable measure-level workstreams.
Coordinate enterprise readiness planning for upcoming NCQA, CMS, HEDIS, and Stars measure changes.
Drive implementation of operational, documentation, coding, workflow, and supplemental data enhancements aligned to measure requirements.
Cross-Functional Leadership & Alignment
Align Quality, Care Management, Pharmacy, Network, Provider Engagement, Analytics, IT, Supplemental Data, and market stakeholders around enterprise priorities, execution, and accountability. Measure Performance Optimization
Analyze measure gaps, performance trends, supplemental data impact, chase outcomes, and intervention effectiveness to prioritize improvement opportunities.
Proactively identify performance risks and operational barriers, recommend remediation, and monitor improvement initiatives for Stars-aligned measures.
Supplemental Data & HEDIS Operations
Assess opportunities for evaluation, integration, mapping, validation, and optimization of supplemental data sources in partnership with Systems and technical teams.
Ensure documentation workflows and source systems support data integrity, audit readiness, measure capture, and HEDIS reporting accuracy.
Program & Project Management
Maintain enterprise workplans, timelines, risks, dependencies, decisions, and progress reporting while driving stakeholder accountability and continuous improvement. Executive Support & Communication
Develop executive materials, performance analyses, prioritization recommendations, and implementation updates for leadership and governance forums. Required Qualifications
Deep expertise in HEDIS specifications, Medicare Star Ratings, supplemental data, and enterprise quality operations.
Demonstrated success leading complex, cross-functional Medicare quality initiatives and operational workstreams in matrixed organizations.
Strong analytical skills with experience interpreting performance data and operational impacts.
Excellent relationship management and communication skills.
Lean Six Sigma Black Belt preferred certification.
DSNP experience preferred.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Molina Healthcare is a managed care organization that provides health insurance and care management services, primarily serving Medicaid members. The company operates health plans and delivers integrated care coordination across the continuum of care, combining medical management with behavioral health, long-term services and supports (LTSS), and community resources. Molina employs advanced claims processing systems, risk adjustment methodologies, and quality performance management to ensure cost-effective, high-quality member outcomes. The company supports various health plans and regulatory requirements while managing complex operations including provider contracting, benefits configuration, and HEDIS audit compliance.
