HEDIS / Stars Quality Manager (Health Plan) Recruiters

A health plan needs this manager to connect measure reporting with operational changes. The work includes reviewing results, tracing missing evidence, coordinating provider outreach, and explaining what changed between reporting cycles. We screen for ownership of those decisions, not familiarity with quality terminology alone. Your search should identify which products, reporting responsibilities, and teams the manager will oversee.

HEDIS experience and Medicare Stars experience overlap, but they are not interchangeable. A candidate may have managed medical record collection without owning broader Stars improvement work. Ask which measures they handled, what decisions they made, and who validated the final results. Strong answers separate personal accountability from work performed by analysts or vendors.

This manager may spend a morning investigating an unexpected rate change and an afternoon resolving an outreach bottleneck. You need someone who can question the denominator, check data timing, and explain the operational consequence. We ask how candidates handled disagreements among quality, analytics, clinical operations, and provider relations without treating every disagreement as a reporting defect.

We look across health plan quality departments, Medicare Advantage quality teams, managed care organizations, and quality reporting service organizations. Provider organizations with substantial payer quality work can also supply candidates. We distinguish supporting a plan’s measures from owning the plan’s reporting calendar, improvement program, and internal decision process.

A candidate might move for clearer ownership, a different product mix, or direct responsibility for staff and improvement budgets. Someone leaving a vendor may want longer-term involvement after reporting ends. We test those reasons against your actual role, especially when the position combines technical oversight with provider engagement.