Director Stars & Member Experience
Listed on 2026-08-13
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Management
Corporate Strategy, Operations Management, Change Management
Location Address:
9521 San Mateo NE Albuquerque, NM
Summary:The Director, Stars & Member Experience provides strategic leadership for Presbyterian Health Plan's Medicare Star Ratings, CAHPS, Health Outcomes Survey (HOS), and Member Experience programs. This position is responsible for leading the Star program and developing and executing enterprise strategies that improve member experience, quality outcomes, and financial performance while supporting the organization's strategic and regulatory objectives.
The Director leads the Member Experience Program and serves as the organization's primary expert in member experience strategy and customer insights across all LOBs as well as the Medicare Stars program. Through influence and collaboration, this leader promotes a member-centered culture and ensures that the voice of the member is incorporated into organizational decision-making, program design, quality initiatives, and operational strategies.
This role is accountable for Medicare Star Ratings performance, CAHPS and HOS outcomes, member experience measurement, survey administration, vendor oversight, and enterprise-wide improvement efforts designed to achieve exceptional member experiences and quality results.
Work Arrangement:- Remote:
Open to applicants in the United States, excluding CA, IL, ND, NY, OH, WA, and WY. - Hybrid (Strongly Preferred):
For individuals within 60 miles of Albuquerque, in-office presence is required Tuesday through Thursday.
- Develop and execute the organization's Medicare Stars strategy to achieve annual quality and financial performance goals.
- Lead enterprise efforts to improve Star Ratings, CAHPS results, HOS outcomes, and member satisfaction.
- Establish governance structures, performance goals, and accountability frameworks for Stars-related initiatives.
- Monitor performance trends and identify opportunities to improve clinical quality, member experience, and operational effectiveness in collaboration with Quality Performance Improvement team and the HEDIS operations team,
- Partner with Population Health, Behavioral Health, Risk Adjustment, Provider Relations, Customer Service, Network Management, and Care Management teams to improve performance outcomes.
- Lead the design and implementation of member-centric experiences across the organization.
- Identify strategic opportunities to improve the member journey and collaborate with stakeholders to redesign processes and services.
- Promote a culture where member impact is a key consideration in organizational decision‑making.
- Stay current on emerging customer experience methodologies, best practices, and industry trends.
- Translate member insights into actionable recommendations for business leaders.
- Analyze member feedback, survey results, complaints, grievances, and operational data to identify trends and improvement opportunities.
- Develop a deep understanding of member needs, expectations, motivations, and barriers through research and data analysis.
- Oversee administration of member experience measurement programs, including CAHPS, HOS, satisfaction surveys, and other voice-of-customer tools.
- Recommend strategic priorities and improvement initiatives designed to strengthen member satisfaction and quality outcomes.
- Anticipate risks that may impact organizational performance and proactively elevate concerns and recommended actions.
- Present performance reports and strategic recommendations to executive leadership, quality committees, and governing bodies.
- Lead enterprise-wide improvement initiatives focused on member experience and quality performance.
- Ensure improvement efforts are supported by appropriate methodologies, documentation, tracking, and alignment with organizational strategic goals.
- Partner with operational leaders to implement targeted interventions that improve survey performance and member outcomes.
- Evaluate effectiveness of initiatives and communicate progress, outcomes, and lessons learned.
- Define key performance indicators that measure what matters most to members.
- Develop executive dashboards and board‑level metrics related to Stars, CAHPS, HOS, and member experience.
- Establish performance monitoring and reporting…
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