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Capital Blue CrossPosted 10/21/2026full-timeHarrisburg • Pennsylvania • United StatesLead💰 $122,790 - $228,030 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive expertise in HEDIS strategy development and improvement, with a strong focus on Medicare Advantage Star Ratings and regulatory compliance. Proven ability to lead cross-functional initiatives and foster partnerships across clinical, analytics, and technology domains.
Highest-signal resume keywords
HEDIS Strategy DevelopmentMedicare Advantage Star RatingsClinical Data AcquisitionExecutive CommunicationHEDIS Methodology Expertise
About the role
Key responsibilities & impact- Develop, lead, and own the multi-year enterprise HEDIS strategy, including measures influencing Medicare Advantage Star Ratings
- Translate CMS, NCQA, Stars methodology, regulatory changes, performance data, and industry trends into actionable priorities
- Oversee the full HEDIS lifecycle, including data acquisition, supplemental data, chart retrieval, abstraction, validation, audit readiness, submission, and transition to digital quality measurement
- Monitor performance across measures, providers, markets, products, and populations; identify gaps, risks, and opportunities; and ensure corrective action
- Build and manage HEDIS improvement initiatives, provider performance strategies, and digital quality transformation efforts
- Partner with Provider Network, Analytics, Data/IT, Government Programs, Care Management, Pharmacy, Member Experience, Compliance, vendors, auditors, and consultants
- Establish governance, decision rights, escalation paths, and shared accountability across functions
- Develop forecasts, performance reporting, early warning indicators, and executive-level insights
- Lead, develop, and retain HEDIS and quality talent
- Strengthen measure-level expertise, documentation, cross-training, succession planning, and sustainable operating processes
- Foster focus, transparency, disciplined execution, constructive challenge, and shared accountability
- Provide strategic oversight of provider, vendor, auditor, and consultant partnerships
Requirements
What you’ll need- Minimum 7 years of progressively responsible experience leading HEDIS strategy and improvement in a health plan
- Measurable results on measures contributing to Medicare Advantage Star Ratings
- Demonstrated SME depth in medical record retrieval, abstraction, over-read, validation, and audit readiness
- Proven ability to lead complex, cross-functional initiatives in a highly matrixed organization spanning clinical, provider, analytics, pharmacy, and technology functions
- Strong analytical and financial acumen
- Exceptional executive communication, presentation, and influencing skills
- Expertise in ECDS reporting, clinical data acquisition and interoperability, including FHIR and standardized clinical terminology
- Advanced knowledge of HEDIS methodology, NCQA requirements, CMS Star Ratings, supplemental data, and measure specifications
- Master’s degree in healthcare administration, public health, nursing, health sciences, business, health informatics, or related field
- Preferred: experience at a consistently high-performing Medicare Advantage plan, including 4+ or 5-Star organizations, across HMO, PPO, and/or D-SNP products
- Preferred: experience integrating HEDIS strategy with CAHPS, medication adherence, provider performance, and risk adjustment
- Preferred: experience with HEDIS vendors, NCQA-certified auditors, quality technology platforms, and EHR/clinical data exchange
- Preferred: Lean, Six Sigma, or related quality improvement certification
- Preferred: experience presenting to C-suite or Board-level committees
Benefits
Comp & perks- Medical, Dental & Vision coverage
- Retirement Plan
- Paid Time Off
- Holidays
- Volunteer time off
- Incentive Plan
- Tuition Reimbursement
- Flexible work environment
- Training and continuing education
- Professional and personal growth support
- Community volunteering opportunities
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
HEDIS Lifecycle ManagementData AcquisitionChart RetrievalValidationAudit ReadinessPerformance MonitoringForecastingAnalytical SkillsFinancial AcumenMeasure Specifications
Soft Skills
LeadershipInfluencing SkillsCross-Functional CollaborationTransparencyConstructive Challenge
Tools & Technologies
ECDS ReportingFHIRQuality Technology PlatformsEHRClinical Data Exchange
Certifications & Qualifications
Lean CertificationSix Sigma Certification
Industry Keywords
CMSNCQAStars MethodologySupplemental DataCAHPSMedication AdherenceProvider PerformanceRisk AdjustmentMedicare Advantage PlanD-SNP Products