Medical Affairs Lead

About the role

The Medical Affairs Lead drives the strategic administration and oversight of clinical quality metrics within the Medicare Star Ratings program. As the subject‑matter expert for clinical performance, you will translate regulatory requirements into actionable strategies, manage risk, and ensure audit readiness.

Key responsibilities

• Design and implement clinical work plans aimed at improving Medicare Star initiatives and overall plan performance.
• Serve as the expert on Star measure specifications, analyzing data to identify trends, gaps, and improvement opportunities.
• Ensure compliance with CMS regulations, support audit preparation, and execute corrective actions.
• Document and report initiative status, outcomes, and issue resolutions to maintain transparency.
• Facilitate meetings with measure owners, implementation teams, and stakeholders to review progress and adjust plans.
• Prepare leadership‑ready presentations, reports, and analyses highlighting results, risks, and recommendations.
• Support strategic planning sessions with internal and external partners to align priorities and optimize outcomes.

Required profile

• Bachelor’s degree in Nursing, Health Care Administration, Public Health, or a related health field.
• Minimum five years of experience in program administration, health‑care data analytics, and quality improvement, specifically with Medicare Advantage Star Ratings or HEDIS.
• Proven ability to manage complex initiatives, track performance metrics, and drive continuous improvement.

Required skills

• Health care data analytics