Measure Optimization Lead - Care Coordination

The Measure Optimization Lead - CC addresses complex business challenges affecting HEDIS Care Coordination measure performance. The role uses established reporting, operational knowledge, and input from internal and external partners to provide insights and recommendations to decision-makers. The Measure Optimization Lead works across initiatives of diverse scope and complexity, ranging from moderate to substantial.

The Measure Optimization Lead - CC addresses complex business challenges affecting HEDIS Care Coordination measure performance. The role uses established reporting, operational knowledge, and input from internal and external partners to provide insights and recommendations to decision-makers. The Measure Optimization Lead works across initiatives of diverse scope and complexity, ranging from moderate to substantial. The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures covering preventive care screenings, health condition management, health outcomes, patient experience, and plan operations.

In this pivotal role, you will provide HEDIS subject matter expertise and strategic leadership to advance Care Coordination measure performance. You will identify improvement opportunities, guide cross-functional initiatives, and translate approved reporting and analysis into clear recommendations for leadership. Your work will directly support decision-making and Stars improvement efforts that improve member care, strengthen plan quality, and advance organizational goals.

• Lead the HEDIS Care Coordination measure optimization strategy and identify opportunities to improve performance.
• Evaluate business and operational factors affecting measure outcomes and recommend targeted improvements.
• Translate measure requirements, performance insights, and business needs into clear priorities and implementation plans.

• Prepare high-quality materials and recommendations for vice presidents and senior leadership discussions.
• Participate in strategic conversations, providing actionable insights and clear recommendations.
• Communicate complex HEDIS, operational, and performance concepts in a clear and compelling manner to non-technical audiences.

• Collaborate with quality improvement, clinical, operations, technology, analytics, and vendor teams to assess and enhance Care Coordination measure performance.
• Lead initiatives from opportunity identification and business requirements through implementation and continuous improvement.
• Identify and resolve business and operational barriers affecting workflows, supplemental data pathways, source connectivity, and ownership.
• Act as a HEDIS subject matter expert, explaining measure requirements, methodology, and performance implications.
• Partner with analytics teams to frame business questions, interpret approved analyses, and translate findings into practical recommendations.

• Define business reporting requirements and success measures for Care Coordination initiatives.
• Use established dashboards and reporting to communicate key metrics, trends, risks, and improvement opportunities.
• Promote accuracy, consistency, and clarity in business materials and executive communications.

• Bachelor’s degree
• 7 or more years of experience in data analysis and/or business intelligence
• 3 or more years of experience with Medicare Advantage, Stars programs, HEDIS measures, or healthcare quality improvement
• Strong understanding of CMS Star Ratings
• Experience with business intelligence tools such as Power BI, Tableau, Qlik, SQL, or similar platforms
• Experience defining business questions and requirements for analytical and technical partners
• Ability to interpret reporting and analytical findings, identify root causes and performance drivers, and translate insights into practical recommendations
• Proven ability to work across business, clinical, operational, technology, analytics, and vendor teams
• Experience leading complex initiatives, managing accountability, resolving issues, and influencing outcomes without direct authority
• Excellent communication and presentation skills, with the ability to convey complex concepts clearly to senior leadership

• Experience with Care Coordination…