Medical Director, Quality & STARS

Description

Medica is a nonprofit health plan with more than a million members that serves communities in Minnesota, Nebraska, Wisconsin, Missouri, and beyond. We deliver personalized health care experiences and partner closely with providers to ensure members are genuinely cared for.

We're a team that owns our work with accountability, makes data-driven decisions, embraces continuous learning, and celebrates collaboration - because success is a team sport. It's our mission to be there in the moments that matter most for our members and employees. Join us in creating a community of connected care, where coordinated, quality service is the norm and every member feels valued.

The Medical Director - Quality and Stars provides clinical leadership and strategic direction to advance quality improvement, population health, and health equity across the organization. This enterprise-wide role supports performance in key programs including CMS Part C and D Stars, HEDIS, Medicaid Withhold, and other regulatory and accreditation standards. The Medical Director collaborates with quality, clinical, and operational teams to improve care delivery and outcomes for members, with a strong focus on data-driven strategies and provider engagement. In partnership with the Senior Medical Director, this role represents clinical perspectives in enterprise initiatives and supports efforts to enhance provider and member engagement. The Medical Director also chairs the Credentialing Committee, guiding credentialing and recredentialing decisions in alignment with clinical standards and regulatory requirements. Performs other duties as assigned.

This position requires strong clinical expertise, experience in quality improvement, and the ability to build collaborative relationships across clinical and non-clinical teams to drive measurable improvements in quality performance.

Key Accountabilities

Quality and Stars Performance Support

• Provides clinical partnership and support to the Quality and Stars team in executing enterprise-wide quality improvement initiatives
• Collaborates with the Quality and Stars team to improve performance on HEDIS, CAHPS, CMS Part C and D Stars, and other regulatory and accreditation metrics
• Offers clinical insight to support strategies for gap closure, member and provider engagement, and performance improvement
• Leads select initiatives and partnerships aligned with the annual Quality and Stars strategy, bringing clinical insight and innovative approaches to improve outcomes
• Provides influential leadership within the team by contributing new and unique strategies to elevate performance and member experience

Population Health and Health Equity

Cross-Functional Collaboration and Clinical Oversight

Committee Participation

Participates in and contributes to enterprise committees and initiatives, including :

Other duties as assigned

Collaborates with Medica clinical leaders to support and inform the overall clinical value strategy

Required Qualifications

Required Certifications / Licensure

Must be a licensed physician with current Board certification of ABMS recognized specialty. Current medical license to practice must be without restrictions. Must be willing and able to successfully apply for medical license in other states as needed.

Skills & Abilities

This position is an Office role, which requires an employee to work onsite, on average, 3 days per week. We are open to candidates located near one of the following office locations : Minnetonka, MN, Madison, WI, Omaha, NE, or St. Louis, MO.

The full salary grade for this position is $200,900 - $344,400. While the full salary grade is provided, the typical hiring salary range for this role is expected to be between $200,900 - $301,350. Annual salary range placement will depend on a variety of factors including, but not limited to, education, work experience, applicable certifications and / or licensure, the position's scope and responsibility, internal pay equity and external market salary data. In addition to base compensation, this position may be eligible for incentive plan compensation in addition to base salary. Medica offers a generous total rewards package that includes competitive medical, dental, vision, PTO, Holidays, paid volunteer time off, 401K contributions, caregiver services and many other benefits to support our employees.

The compensation and benefits information is provided as of the date of this posting. Medica's compensation and benefits are subject to change at any time, with or without notice, subject to applicable law.

We are an Equal Opportunity employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.

Equal Opportunity Employer / Protected Veterans / Individuals with Disabilities

This employer is required to notify all applicants of their rights pursuant to federal employment laws.

For further information, please review the Know Your Rights notice from the Department of Labor.