Senior Director, Quality Ratings & Network

Who we are

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

• Strive to apply an equity lens to all our work.
• Reduce health disparities.
• Create an equitable work environment.

The Senior Director, Quality Ratings and Network Performance leads strategic initiatives to improve health plan quality ratings and provider performance, with a focus on Medicaid, Exchange, and D‑SNP populations. This role is responsible for collaborating across the organization with other key stakeholders and leaders to drive measurable improvements in official HEDIS, HOS, and CAHPS performance and reporting, as well as execution of provider strategies to drive measurable improvement, while ensuring compliance with state and federal regulatory requirements.

Key to success in this role includes bringing a deep expertise in Medicaid and Medicare quality programs, analytic approaches to conducting comprehensive evaluations and outcome measurement of rapid cycle improvement strategies, HEDIS, CAHPS and HOS program management and strategic approaches to optimizing data procurement and reporting, D‑SNP Star program management, and value‑based provider strategies.

• Possess a Bachelor’s degree in healthcare administration, public health, nursing, healthcare economics, or related field; a Master’s degree is highly preferred.
• Have ten (10)+ years of experience in healthcare quality, performance improvement, or healthcare analytics, with a focus on Medicaid, Exchange and/or D‑SNP.
• Have a minimum of seven (7) years of progressive leadership experience.
• Possess a deep knowledge of CMS Stars, HEDIS, CAHPS, HOS and Medicaid‑specific quality programs.
• Have proven leadership in managing cross‑functional teams and complex initiatives.
• Are highly skilled in analytics, communication, and strategic planning.

• Lead strategy and execution for Health Plan ratings strategies (e.g., NCQA, VBP, P4P, EQRO) and D‑SNP Stars ratings.
• Lead data collection and validation for official HEDIS, CAHPS and HOS reporting to regulatory bodies.
• Monitor and analyze performance across HEDIS, CAHPS, and other key health plan rating measures; collaborate with Quality/Population Health leaders to develop and execute targeted improvement plans.
• Collaborate with internal teams to ensure accurate and timely data submission to CMS and state agencies.
• Facilitate and/or oversee the organization’s cross‑functional Star Improvement Committee, as well as cross‑departmental collaborative meetings focused on Health Plan rating measure strategies.
• Manage vendor contracts and provide vendor oversight, including monitoring key performance indicators and ensuring adherence to contract terms to support Star and/or quality programs.

• Develop and implement provider engagement strategies to improve quality outcomes for Medicaid, Exchange and D‑SNP members.
• Partner with network management, clinical operations, and analytics to identify performance gaps and drive improvement.
• Lead clinic partnerships and data integration team to effectively deploy practice transformation and quality coaching models with the CHC network.
• Oversee strategies to leverage provider‑facing tools, dashboards, and education to support quality and compliance goals.

• Lead a cohesive and motivated team of professionals and analysts focused on employing continuous quality improvement techniques leveraging data effectively to support rapid cycle improvements in performance.
• Serve as a strategic advisor to executive leadership on quality trends, risks, and opportunities.
• Foster a culture of accountability, innovation, and continuous improvement.
• Collaborate with leaders in Clinical Services and across the organization to identify and facilitate improvement projects to enhance organizational performance on quality…