D-SNP Stars & Clinical Principal

Become a part of our caring community and help us put health first

Be part of Medicaid’s D-SNP Center of Excellence. This role is responsible for supporting Quality and Stars within Medicaid DSNP markets, serving as a subject matter expert for Stars‑related initiatives, and ensuring their effective activation and integration throughout the Insurance Operations organization. This role will be focusing on advancing quality outcomes and access.

Medicaid DSNP Operations encompasses critical functions including care coordination, quality measurement, billing, claims processing, and customer service, each essential to delivering a comprehensive and high‑quality member experience.

In this role, you will identify and engage with Quality and Stars‑related initiatives within Medicaid DSNP markets to understand the business strategy, scope, and goals, building a working knowledge to inform identification and validation of potential synergies, business‑specific requirements, risks, and integration paths. This role will manage relationships and build trust with key enterprise partners critical for integrated D‑SNP; gaining alignment on cross‑asset integration opportunities, identify and implement new initiatives.

Scales best practices and creates standardization opportunities across integrated states. In addition, this role will support the optimization of Stars measures and initiatives that impact integrated D‑SNPs; identifying gaps and opportunities for greater collaboration across Medicaid and Medicare segments. This role requires a deep understanding of operations and how it connects with enterprise Stars governance and initiatives.

• Oversight of related budget, vendor relationships, and program/ project management

• Serve as the primary liaison for Stars initiatives within Medicaid D‑SNP, building deep operational knowledge of core functional areas (care coordination, quality, billing, claims, and customer service).

• Supports prioritization and resolution of market issues working across Medicare and Medicaid market teams and Medicare and Medicaid centralized services

• Be the primary business partner with Medicare Stars organization to identify, understand, and align Stars‑related business strategies, objectives, and operational requirements to drive D‑SNP member experience.

• Enhances and aligns data sharing processes between Medicare and Medicaid Evaluate business processes across Insurance Operations to identify synergies, integration opportunities, and operational risks related to Stars performance and compliance.

• Scales best practices and creates standardization opportunities across integrated states

• Coordinate with analytics and reporting teams to generate actionable insights, enabling data‑driven prioritization of operational improvements that directly impact Stars measures.

• Advances integrated care‑team approaches across Medicare and Medicaid

• Partner with segment and enterprise Stars leaders to advance cross‑functional initiatives, ensuring alignment between operational execution and Stars strategy.

• Maintain a comprehensive inventory of Stars initiatives within Insurance Operations, identifying gaps and facilitating collaboration to maximize impact across all operational areas.

• Lead and support the design, implementation, and optimization of Stars‑related programs and processes within Insurance Operations, including performance monitoring and continuous improvement.

• Oversee test‑and‑learn pilots to validate solutions and measure operational effectiveness, using results to inform broader implementation.

• Develop and deliver regular reports on Stars operational performance to executive leadership, providing clear visibility into progress, challenges, and opportunities.

• Manage budgets, vendor relationships, and project plans to support the successful delivery of Stars‑focused operational initiatives.

Use your skills to make an impact

• Bachelor’s degree

• 5 + years of quality improvement, developing & advancing enterprise strategy, insurance operations experience, i.e.: claims, UM, CM, call center, enrollment, etc.

• 3+ years of CMS Stars program experience

• Previous leadership…