Job Description

Job Title: Senior Director CMS Quality & Stars Program
Job ID: 640737
Status: Full-Time
Regular/Temporary: Management
Shift: Day Job
Facility: UPMC Health Plan
Department: Quality Improvement
Location: 600 Grant St, Pittsburgh PA 15219


Do you have an extensive background within managed care? Are you knowledgeable of CMS Stars and have experience to show success? Do you have involvement in a large health plan system? UPMC may have the perfect fit for you!


UPMC is actively seeking a full time Senior Director CMS Quality and Stars Program. The Senior Director is accountable for health plan strategy and performance on CMS Stars and leadership of health plan CMS Stars team. Strategically develops member and provider interventions and programs that support the success of the health plan CMS Star program. Oversight of CMS Star results, regulations, integrated operational and clinical teams and all aspects of star analysis. Drives an innovative and proactive CMS Star improvement strategy and team. In addition, responsible for Medicare and SNP CMS quality requirements.


  • Assist with strategies for provider incentive programs related to CMS Star measures and scoring
  • Collaborate with health plan leaders to review and determine member incentive decisions
  • Collaborate with population health management strategy and operations to ensure CMS Star measures have actionable tactics
  • Conduct analysis of star data including demographics, disparities and social determinants
  • Conduct annual review of peer health plan ratings to identify and explore best practices
  • Develop process to regularly receive ideas on innovation and new methods of performance for CMS Stars
  • Explore enhanced messaging techniques and technology for members and providers related to CMS Stars and quality gap closure.
  • Identify opportunities for new focus areas for additional incentive types, such as employees and health plan departments
  • Implement and direct cross departmental core teams to increase all aspects of the CMS star metrics
  • Implement community partnerships related to improving star measure results
  • Lead Health Plan CMS Stars team to achieve summary score of 4 or above for all applicable health plan contracts
  • Management of CMS quality reporting for Medicare and SNP
  • Monitoring of technical measure specifications and providing education to health plan related departments
  • Oversight of CMS Star rates published by CMS, including monthly HPMS reports and annual validation process
  • Proactively analyze and implement actions related to network expansion efforts as it relates to CMS star strategy
  • Produce dashboards, trend and surveillance reports for senior management and department leaders and teams tracking individual measure and interventions performance
  • Report CMS stars status, results, strategy for improvement to the executive level CMS Stars Oversight team
  • Review industry products routinely for new reporting, analysis and modeling opportunities
  • Support system enhancements that support gap closure automation such as EMR feeds and electronic data extraction


  • Bachelors Degree in healthcare administration, nursing, hospital administration, business, public health or related field, Masters preferred, or comparable work experience considered.
  • Seven to ten years managed care experience preferred
  • Multiple years experience with CMS Stars management and knowledge of CMS Stars regulatory requirements
  • Excellent communication skills; verbal, written, and interpersonal.
  • Strong analytical and problem solving skills. Strong leadership skills and independent decision making ability.
  • Computer skills in Word, Excel and Outlook required

    Licensure, Certifications, and Clearances:
    UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $0 to $0

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!


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