Medical Affairs Lead

GENERAL DESCRIPTION: The Medical Affairs Lead is responsible for the strategic administration and oversight of all clinical quality metrics within the Medicare Star Ratings program. Serves as the subject matter expert for clinical performance, ensuring all initiatives are executed, tracked, and optimized to achieve the highest possible Centers for Medicare Medicaid Services (CMS) ratings. Translates regulatory requirements into actionable clinical strategies, managing risks and documenting progress to ensure organizational success and audit readiness. ESSENTIAL FUNCTIONS: • Leads the design and implementation of clinical work plans specifically tailored to improve Medicare Star initiatives and overall plan performance. • Serves as subject matter expert in Star measure technical specifications, identifying trends, gaps in care, and opportunities for performance improvement through detailed data reporting. • Ensures all clinical initiatives comply with Centers for Medicare Medicaid Services (CMS) regulations and guidelines, participates in audit preparation and implements corrective actions as needed. • Provides continuous follow-up, documentation, and reporting on initiative status, outcomes, and resolution of identified issues, ensuring accountability and transparency. • Coordinates and facilitates meetings with measure owners, implementation teams, and stakeholders to review progress, update plans, address risks, and identify alternative solutions. • Requests, reviews, and validates timely updates from initiative and measure owners, updating workplans to reflect enhancements, changes, or cancellations. • Prepares and delivers leadership-ready presentations, reports, and analyses for senior management, highlighting key results, risks, and recommendations. • Supports strategic planning sessions with internal stakeholders, departments and/or external consultants, to align initiatives, define priorities, and optimize outcomes. • Follows up on action items and resolutions assigned, providing timely status updates and ensuring completion. • Prepares materials and documentation supporting Star strategic initiatives, leadership reviews, and decision-making processes. • Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices. • May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document. MINIMUM QUALIFICATIONS Education and Experience: B achelor’s degree preferably in Nursing, Health Care Administration, Public Health, or health related field. At least five (5) years of experience performing role-related tasks such as program or initiative administration, health care data analytics with specific expertise in Medicare Advantage Star Ratings, HEDIS, or quality improvement. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: A valid Nurse Association Nursing Professionals of Puerto Rico License and Registration is preferred. Lean Six Sigma Green Belt or higher is preferred. Other: N/A Languages: Spanish – Intermediate (comprehensive, writing and verbal) English – Intermediate (comprehensive, writing and verbal)