"Alerted.org

Primary City/State:

Phoenix, Arizona

Department Name:

Clinical Decision Making

Work Shift:

Day

Job Category:

General Operations

Join Banner Plans & Networks as a Senior Director of Stars and Quality and lead the charge in transforming member experience and driving excellence in health outcomes. In this pivotal role, you’ll shape strategy, inspire innovation, and elevate performance across Medicare Advantage and quality programs. If you’re passionate about improving lives through data-driven insights, operational excellence, and collaborative leadership, this is your opportunity to make a lasting impact with one of the nation’s most respected integrated health systems.

Your pay and benefits are important components of your journey at Banner Health. This opportunity includes the option to participate in a variety of health, financial, and security benefits. In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards package.

Banner Plans & Networks (BPN) is an accountable care organization that joins Arizona's largest health care provider, Banner Health, and an extensive network of primary care and specialty physicians to provide the most comprehensive healthcare solutions for Maricopa County and parts of Pinal County. Through BPN, known nationally as an innovative leader in new health care models, insurance plans and physicians are coming together to work collaboratively to keep members in optimal health, while reducing costs.

POSITION SUMMARY

This position provides mission-critical leadership by guiding, influencing, and coordinating cross-functional efforts to achieve and sustain four to five Star performance across all CMS Star rating domains, including HEDIS, CAHPS, HOS, Health Plan Operations, Pharmacy (Rx), and overall Quality Improvement. The Senior Director acts as a catalyst and Medicare Advantage Star and Quality subject matter expert, translating organizational vision into aligned strategies for Star success. The role is designed as a matrixed leadership position - without direct line authority for all measured domain - which depends on expert facilitation, persuasive communication, and skillful collaboration. Success is driven by aligning diverse stakeholders across Banner Plans and Networks (BPN), including core operations, quality, pharmacy, IT, analytics, provider networks, care management, member experience, compliance, and regulatory teams. This role builds consensus, nurtures partnerships, and leverages shared accountability to deliver results through others.

In partnership with BPN quality leadership, this role is the health plan’s accountable leader who drives and collaborates on Medicare Advantage quality program strategies and initiatives, providing Stars and quality program subject matter expertise to ensure alignment between health plan quality programs and Stars performance objectives.

This role is responsible for increasing organizational knowledge, building multi-level engagement, and ensuring continuous improvement by influencing adoption of best practices and innovative solutions that lead to a high-performance quality plan. The role also advances health equity efforts, incorporates member and provider perspectives to maximize impact and has direct responsibility for ensuring the accuracy and timeliness submission of CMS Part C and D data, including oversight of the annual CMS validation audit.

CORE FUNCTIONS

1. Stars Strategy and Execution: Acts as the internal Stars expert, providing guidance, education, and technical support to functional leaders accountable for individual measures; delivers data-driven recommendations, synthesizes regulatory updates, and translates external trends into actionable strategies for success. Drives comprehensive strategic planning and initiative development for Medicare Advantage Stars and Quality programs assuring full accountability for performance analytics, reporting, and achievement of Stars-related targets and quality improvement opportunities. Champions system-wide initiatives to advance health equity, support SDOH, and address disparities in Stars domains; ensures these priorities are embedded in all collaborative strategies.

2. Strategic Collaboration and Facilitation: Proactively builds and maintains strong relationships with all leadership levels and key contributors. Implements formal and informal mechanisms to capture insights, address barriers, and drive ongoing communication between teams. Leads and convenes multi-disciplinary work groups, ensuring coordinated Stars and Quality strategies across clinical, pharmacy, IT, contracting, analytics, and member experience teams; success is dependent on forging consensus and enabling high performance through others.

3. Data-Driven Insight and Performance Reporting: Partners with analytics, digital engagement, and technology leaders to identify, prioritize, and support deployment of tools and programs enabling gap closure and superior member/provider engagement. Tracks, interprets, implements rigorous data validation, accuracy checks and completeness to ensure reliability and integrity of reported metrics and communicates key performance indicators, but relies on operational teams for direct execution; monitors progress and holds cross-functional teams accountable through transparency and communication.

4. Clinical Integration & Data Leadership: Acts as a bridge between administrative and clinical stakeholders, fostering credible dialogue and consensus on strategic options and operational challenges. Identifies unintended barriers to performance rooted in clinical workflow, supports adoption of new models, and helps teams interpret policy changes from a clinical vantage. Ensures that initiatives respect and optimize clinical staff efforts, while advancing Stars and quality program goals.

5. Team and Budget Oversight: Provides leadership to direct team members, fostering their success and accountability in achieving department goals. Develops and oversees the department budget to meet Stars performance goals and objectives. Translates organizational Stars and Quality plans into assumptions for annual operating and/or capital budgets. Negotiates contracts with external vendors for products and/or services and monitors/evaluates quality and/or performance.

MINIMUM QUALIFICATIONS

Must possess strong knowledge of healthcare and health plan operations as normally obtained through the completion of a Bachelor's Degree in Business Administration in healthcare administration, nursing, public health, business, or related field.

Seven plus years of progressive experience in healthcare quality management, with at least three to five years specifically in Medicare Advantage Stars (HEDIS, CAHPS, HOS) or CMS quality programs.

Demonstrated success leading teams and cross-functional initiatives, with strong project/program management skills. Experience with budgeting, resource allocations, and vendor evaluation in health plan setting. Advance ability to analyze data, use quality improvement methodologies, and drive performance outcomes in complex environments.

Excellent relationship management, verbal/written communications, and leadership abilities.

PREFERRED QUALIFICATIONS

Master’s degree preferred.

Robust clinical expertise gained through education, licensure, and/or frontline healthcare experience to guide quality improvement strategy and ensure effective translation of clinical evidence into best practices preferred.

Previous experience in value-based revenue and quality improvement initiatives with various health insurance products(s)

Additional related education and/or experience preferred.

EEO Statement:

EEO/Disabled/Veterans (https://www.bannerhealth.com/careers/eeo)

Our organization supports a drug-free work environment.

Privacy Policy:

Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy)

EOE/Female/Minority/Disability/Veterans

Banner Health supports a drug-free work environment.

Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability