Director Clinical Quality Performance & Improvement
Cambia Health Solutions
Newcastle, WA
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JOB DETAILS
JOB TYPE
Full-time, Employee
SKILLS
Artificial Intelligence (AI), Business Administration, Business Intelligence Software, Centers for Medicare and Medicaid Services (CMS), Content Management Systems (CMS), Cross-Functional, Customer Experience, Forecasting, Health Economics, Healthcare, Healthcare Administration, Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Quality, Leadership, Lean Six Sigma, Medicare, Medications, National Committee for Quality Assurance (NCQA), Nursing Administration, Operations Planning, Performance Analysis, Performance Management, Power BI, Predictive Modeling, Process Improvement, Project Management Professional (PMP), Project/Program Management, Public Health, Quality Metrics, Reporting Dashboards, Risk Analysis, Risk Modeling, Six Sigma Black Belt, Six Sigma Green Belt, Statistics, Strategic Planning, Systems Maintenance, Tableau, Team Building, Technical Presentation, Technical Writing
LOCATION
Newcastle, WA
POSTED
10 days ago
Oregon, Washington, Idaho or Utah (Hybrid)
Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system.
Who We Are Looking For:
Every day, Cambia's dedicated team is living our mission to make health care easier and lives better. As a member of the Enterprise Quality team, our Director, Clinical Quality Performance and Improvement leads the execution of the enterprise Medicare Stars strategy, driving sustained performance improvement through targeted initiatives, robust analytics, and cross-functional collaboration. This role translates strategic priorities into actionable plans, establishes the operational infrastructure needed to achieve Stars goals, and ensures the organization has the measure-level insights and program management capabilities required for success- all in service of creating an economically sustainable health care system.
As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us.
Are you a Stars expert with a proven track record improving Medicare Stars ratings through data-driven initiatives and cross-functional collaboration? Then this role may be the perfect fit.
What You Bring to Cambia:
Qualifications:
* Bachelor's degree in Healthcare Administration, Public Health, Nursing, Business Administration, or related field, Master's degree (MBA, MHA, MPH, or related) strongly preferred.
* 12+ years of progressive healthcare quality or performance improvement experience including 8+ years of direct Medicare Stars program experience, including measure-level performance improvement and CMS reporting.
* 5+ years of people leadership experience with demonstrated success building and developing quality teams or equivalent combination of education and experience.
* CPHQ, Lean Six Sigma Green Belt or Black Belt, or PMP preferred
Skills and Attributes:
* Medicare Advantage Expertise: Proven track record improving Stars ratings through data-driven initiatives, with deep knowledge of CMS methodology, measure specifications, and Part D requirements
* Stars Performance Management: Experience implementing Stars-specific interventions including gaps in care programs, medication adherence initiatives, and member experience improvements
* Advanced Analytics & Forecasting: Strong proficiency in performance analytics, statistical forecasting, predictive modeling, and BI tools (Tableau, Power BI) for dashboard development
* Healthcare Quality Standards: Solid understanding of NCQA HEDIS measures, risk adjustment models, value-based care, and population health management principles
* Process Improvement Methodology: Knowledge of Lean, Six Sigma, PDSA, or similar improvement frameworks to drive systematic quality enhancements
* Cross-Functional Leadership: Ability to influence and drive results in matrix environments, building trusted partnerships with clinical, operational, and technical stakeholders without direct authority
* Strategic Communication: Exceptional skills translating complex data into actionable insights and presenting technical content to diverse audiences, with demonstrated ability to leverage AI tools for efficiency and innovation.
What You Will Do at Cambia:
* Lead annual and multi-year Medicare Stars strategy development, translating priorities into detailed operational plans while monitoring CMS rulemaking and providing leadership recommendations on program implications
* Serve as organizational expert on Medicare Stars requirements, measure specifications, and CMS methodology, ensuring enterprise-wide understanding
To view the full job description, https://www.aplitrak.com/?adid=YmJnZW5lcmljLjYzMjUzLjg3NjlAY2FtYmlhaGVhbHRoY29tcC5hcGxpdHJhay5jb20">click here
About the Company
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Cambia Health Solutions
Cambia Health Solutions is a family of companies headquartered in Portland, Oregon, working to create a person-focused and economically sustainable health care system.
Through our health plans, innovative technology and strategic investments, we are delivering consumer-centric solutions that:
• help people achieve better health and well-being
• make health care more available, affordable and accessible
• are easily understood by everyone
We put people at the heart of everything we do. Our company reaches more than 70 million Americans nationwide, including more than two million people in the Pacific Northwest who are enrolled in our regional health plans.
COMPANY SIZE
5,000 to 9,999 employeesINDUSTRY
Healthcare Services
FOUNDED
1940
WEBSITE
https://www.cambiahealth.com/careers