Medical Director, Quality & STARS

The Medical Director - Quality and Stars provides clinical leadership and strategic direction to advance quality improvement, population health, and health equity across the organization. This enterprise-wide role supports performance in key programs including CMS Part C and D Stars, HEDIS, Medicaid Withhold, and other regulatory and accreditation standards. The Medical Director collaborates with quality, clinical, and operational teams to improve care delivery and outcomes for members, with a strong focus on data-driven strategies and provider engagement. In partnership with the Senior Medical Director, this role represents clinical perspectives in enterprise initiatives and supports efforts to enhance provider and member engagement. The Medical Director also chairs the Credentialing Committee, guiding credentialing and recredentialing decisions in alignment with clinical standards and regulatory requirements. Performs other duties as assigned.

This position requires strong clinical expertise, experience in quality improvement, and the ability to build collaborative relationships across clinical and non-clinical teams to drive measurable improvements in quality performance.

Key Accountabilities:

Quality and Stars Performance Support

• Provides clinical partnership and support to the Quality and Stars team in executing enterprise-wide quality improvement initiatives
• Collaborates with the Quality and Stars team to improve performance on HEDIS, CAHPS, CMS Part C and D Stars, and other regulatory and accreditation metrics.
• Offers clinical insight to support strategies for gap closure, member and provider engagement, and performance improvement.
• Leads select initiatives and partnerships aligned with the annual Quality and Stars strategy, bringing clinical insight and innovative approaches to improve outcomes.
• Provides influential leadership within the team by contributing new and unique strategies to elevate performance and member experience.

Population Health and Health Equity

• Provides clinical leadership in advancing population health and reducing health disparities
• Supports integration of social determinants of health into quality and care management strategies.
• Participates in enterprise initiatives focused on health equity, preventive care, and chronic condition management.
• Represent Medica Health at local and national Health Equity forums or committees.

Cross-Functional Collaboration and Clinical Oversight

• Partners with internal stakeholders to drive clinical value and support care management
• Provides physician input on complex care management cases and quality of care reviews.
• Collaborates with analytics teams to leverage data for performance improvement.
• Engages with provider networks to align on quality goals and performance expectations.

Committee Participation

• Participates in and contributes to enterprise committees and initiatives, including:
  
  
  
  • Quality Performance and Improvement
  • Population Health
  • Health Equity
  • Credentialing Oversight
  • Medicaid Withhold and regulatory performance programs
  
  
  
  

Other duties as assigned

• Collaborates with Medica clinical leaders to support and inform the overall clinical value strategy
  
  
  
  • Develops effective working relationships with physician peers, health services and pharmacy leaders as well as other Medica leaders for quality, care management and medical expense initiatives
  • Develops effective working relationships with Medica Provider Analytics and Enterprise Analytics teams to leverage actionable data to drive clinical value initiatives
  • Completes quality of care reviews for cases requiring physician judgment regarding care that was rendered by network practitioners or facilities
  • Serves on other relevant committees requiring physician input, as required
  
  
  
  

Required Qualifications:

• Medical Doctorate (MD) or Doctor of Osteopathic Medicine (DO)
• 5+ years as clinical provider; 2+ years of health plan or health system quality improvement experience strongly desired.

Required Certifications/ Licensure:

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  Must be a licensed physician with current Board certification of ABMS recognized specialty. Current medical license to practice must be without restrictions. Must be willing and able to successfully apply for medical license in other states as needed.

  
  

Preferred Skills:

• Knowledge of HEDIS
• History of physician/team leadership and/or change management
• Improving health equity
• Value-based care
• Vendor management

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations: Minnetonka, MN, Madison, WI, Omaha, NE, or St. Louis, MO.

The full salary range for this position is $200,900 -$344,400. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and/or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.