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Position Summary

The Solution Architect, Epic STARS is responsible for the design, optimization, and strategic direction of Epic-based solutions supporting Medicare Star Ratings, HEDIS, and NCQA quality measure performance. This role bridges clinical quality strategy and technical Epic build, ensuring that quality measure workflows, data capture, and reporting infrastructure within Epic Healthy Planet and related modules accurately support Star Ratings improvement initiatives across the organization. The ideal candidate combines deep Epic technical expertise with a strong understanding of value-based care, population health, and quality measurement methodologies.

Key Responsibilities

Solution Architecture & Design

+ Architect and design Epic Healthy Planet, Reporting Workbench, Clarity/Caboodle, and SlicerDicer solutions to support Medicare Star Ratings, HEDIS, and NCQA measure tracking and gap closure.

+ Translate quality measure specifications (CMS Star Ratings, HEDIS technical specifications, NCQA requirements) into functional and technical Epic build requirements.

+ Design scalable data models and reporting frameworks that support accurate, auditable quality measure calculation and Star Ratings performance monitoring.

+ Own the end-to-end technical roadmap for Epic STARS-related builds, including registries, care gap alerts, best practice advisories (BPAs), and health maintenance topics tied to Star measures.

Stakeholder Partnership & Strategy

+ Partner with Quality, Population Health, ACO, and clinical leadership to understand measure priorities and translate business needs into Epic solutions.

+ Serve as the primary technical liaison between clinical quality teams and Epic build/development teams for all Star Ratings initiatives.

+ Collaborate with data analytics and reporting teams to ensure quality measure data feeds are accurate, timely, and aligned with CMS submission requirements.

+ Present architectural recommendations, risk assessments, and solution options to senior leadership and governance committees.

Build, Delivery & Optimization

+ Lead or oversee Epic build activities related to Star Ratings measures, including registries, health maintenance plans, documentation flowsheets, and quality dashboards.

+ Evaluate existing Epic workflows for gaps in quality measure capture and recommend workflow or build optimizations to improve Star performance.

+ Ensure interoperability between Epic and external quality reporting platforms or vendor tools (e.g., HEDIS engines, risk adjustment vendors) using FHIR/HL7 standards where applicable.

+ Conduct testing, validation, and troubleshooting of quality measure logic to ensure accuracy of Star Ratings-related reporting.

Governance, Compliance & Documentation

+ Maintain thorough documentation of Epic STARS architecture, data flows, and build decisions to support audit readiness and knowledge continuity.

+ Ensure solutions comply with CMS, NCQA, and internal data governance standards.

+ Participate in change control and release management processes for all Star Ratings-related Epic builds.

Innovation & Continuous Improvement

+ Stay current on CMS Star Ratings methodology changes, HEDIS specification updates, and Epic Healthy Planet roadmap enhancements.

+ Identify opportunities to leverage new Epic functionality (e.g., predictive models, care gap automation) to improve Star Ratings outcomes.

+ Mentor junior analysts and build staff on Epic quality measure architecture best practices.

Required Qualifications

+ Bachelor's degree in Health Informatics, Information Systems, Computer Science, or related field (or equivalent experience).

+ 5+ years of experience with Epic, including hands-on work in Healthy Planet, Clarity/Caboodle, Reporting Workbench, or SlicerDicer.

+ Demonstrated experience supporting Medicare Star Ratings, HEDIS, and/or NCQA quality measure programs.

+ Strong understanding of value-based care and ACO population health operations.

+ Epic certification(s) in Healthy Planet or Reporting Cadence, ClinDoc, or related modules strongly preferred.

+ Experience translating clinical/quality specifications into technical build requirements.

+ Familiarity with FHIR/HL7 interoperability standards.

Preferred Qualifications

+ Experience with agile delivery tools (e.g., Rally) for managing build backlogs and release planning.

+ Prior experience in a health plan, ACO, or integrated delivery network environment.

+ Knowledge of risk adjustment and quality reporting vendor platforms.

+ Strong presentation and stakeholder management skills, with experience briefing senior leadership.

Key Competencies

+ Technical depth balanced with strategic, big-picture thinking

+ Strong cross-functional collaboration across IT, clinical, and quality teams

+ Analytical rigor and attention to detail in measure logic and data validation

+ Clear written and verbal communication of complex technical concepts to non-technical stakeholders

Pay Range

The typical pay range for this role is:

$106,605.00 - $284,280.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments (https://learn.bswift.com/cvshealth...

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Epic Healthy Planet-Solution Architect- Epic STARS

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