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Responsibilities:
- Develop and lead the multi-year enterprise HEDIS strategy, including Medicare Advantage Star Ratings measures, with clear targets and performance routines.
- Oversee the full HEDIS lifecycle, including data acquisition, chart retrieval, validation, audit readiness, and digital quality measurement.
- Monitor performance across measures, providers, and products; identify gaps and drive corrective action.
Qualifications:
- Minimum 7 years leading HEDIS strategy and improvement in a health plan, with measurable results on Star Ratings.
- Demonstrated expertise in ECDS reporting, clinical data interoperability (FHIR), and CMS/NCQA requirements.
- Proven ability to lead complex cross-functional initiatives in a matrixed organization with strong analytical and communication skills.
About Us:
- Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association, committed to improving member and community health.
- We foster a flexible environment where wellbeing is prioritized and offer generous benefits and professional growth opportunities.
Capital Blue Cross
Capital Blue Cross is a health insurance company and independent licensee of the Blue Cross Blue Shield Association, focused on improving the health and well-being of its members and communities. The company fosters a flexible, caring culture and is consistently voted one of the "Best Places to Work in PA."