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Director of Medicare STAR Ratings
3 months ago
Job Summary
The Director of Medicare, Star Ratings is a highly visible, senior, strategic leadership role reporting to the Director, Quality Improvement (QI) and is responsible for leading all aspects of the Medicare Star Ratings program with a primary focus on execution of program strategy. The Director is accountable for the overall Stars performance and will be responsible for the following:
- Works with the Director, QI to define the Star Ratings strategy for the organization, including annual and long-term strategic plans for performance improvement
- Flawlessly executes the defined strategy to deliver the set annual performance goals of the health plan.
- Identifying, creating and executing work plans, , tracking, and reporting metrics, as well as managing all Star Ratings initiatives
- Building relationships with and leading cross-functional teams to drive Star Ratings initiatives and best practices by promoting innovation, strategy development, and implementation excellence
- Chairing and facilitating Executive-level committee meetings related to Stars, effectively communicating performance progress, new initiatives needed for higher performance, organizational barriers, and expectations of results
- Staying abreast of and keeping the organization apprised of existing and new Federal/State legislation impacting Star Ratings
- Developing and implementing member centric strategies to engage, educate, and motivate providers to positively impact Star Ratings
- Lead, coach, and teach measure owners and team's end-to-end process improvement cycle such as the definition, documentation, measurement, improvement, and control of processes aimed at optimizing the quality of the Medicare member/provider engagement programs.
- Effectively managing vendors and holding them accountable for high performance based on the strong operational knowledge of the health plan.
- Understands overall organizational processes, operations and challenges that may impact star ratings and provides leadership with visibility on the potential impacts (positive or negative) along with the mitigation efforts.
Qualifications
- Bachelor's degree in health administration or a related field required. Advanced coursework and/or Master's degree desirable. Minimum 3-5 years of managed care experience, specifically in government programs, is required.
- Robust knowledge and strong experience with Medicare Advantage, and specific experience with Star Ratings is a MUST, along with extensive knowledge in Medicare compliance, health plan operations, and quality improvement activities. Detailed, "SME-level" knowledge of HEDIS, CAHPS, HOS, Part D, and Admin. Measures. Strong knowledge and understanding as well as ability to interpret Federal and state regulations.
- 8 – 10 years of healthcare experience with relevant work in Medicare Advantage. Prefer 3 – 5 years of supervisory or leadership experience
