Medicare STAR Program Manager

1 week ago


Santa Barbara CA United States CenCal Health Full time

Job Summary


The Quality Department is committed to preventing disease, ensuring patient safety, and eliminating inequities by improving the quality of care received by members through partnerships with providers and community-based organizations.


The Medicare STARS Program Manager is responsible for informing, promoting, and leading the evolution of CenCal Health’s managed care systems to maximize quality as measured by the Centers for Medicare and Medicaid Services (CMS) 5 STAR Rating System.


Reporting to the Executive Quality and Population Health Officer, the Medicare STARS Program Manager plays a pivotal role to strategically optimize operational initiatives plan wide to maximize CenCal Health’s Duals Special Needs Plan (D-SNP) STAR ratings, and to elevate CenCal Health’s Medicare STAR Rating Program governance.


The successful D-SNP STAR Program Manager is a subject matter expert (SME) in regulations that govern the CMS Medicare D-SNP STAR Rating System, and in the application of operational strategies and tactics to maximize Star Rating System outcomes. The Medicare STARS Program Manager will serve as a high-level individual contributor.


Duties and Responsibilities:


  • Sustained up-to-date D-SNP STARS System subject matter expertise of significant complexity, understanding of the present and future operational impacts of changes to STAR Rating Program requirements.
  • Ability to clearly communicate STAR Rating System requirements and their impacts to operational systems enterprise-wide; collaboration with cross-functional teams to build an understanding of the intersection between STAR Rating requirements and the operational excellence required to achieve exceptional member experience and outcomes.
  • Subject Matter Expertise liaison to stakeholders’ enterprise-wide to provide strategic guidance to support and promote process deployment, refinement, and execution to maximize STAR ratings.
  • Collaborate with cross-functional teams to drive systems improvement to maximize STAR measure ratings, with duties including but not limited to:
  • At least annually develop CenCal Health’s STAR Rating Program strategic objectives as a component of CenCal Health’s Quality Improvement and Health Equity Transformation Program (QIHETP) Work Plan, and in congruence with CenCal Health’s Population Health Management Strategy, and Operating Plan. Update STAR Rating Program strategic objectives quarterly in congruence with emerging requirements and priorities.
  • Optimize use of vendor STARS applications, and design and implement solutions in collaboration with cross-functional stakeholders and the Information Technology Division, to monitor performance relative to CenCal Health’s STAR Rating Program goals and enable effective STAR Rating Program governance.
  • Cultivate and sustain mutually beneficial partnerships with CenCal Health’s vendors that provide systems to monitor and manage STARS performance.
  • Monitor, track, and communicate STARS-related Key Performance Indicator outcomes, to demonstrate and elevate the effectiveness of CenCal Health’s STAR Rating Program.
  • Oversee the preparation and filing of the measures included in the CMS STAR Rating Program and maintain reports and back up information to review preliminary measure results to ensure the accuracy of the STAR Rating Program information.
  • Serve as a SME and resource enterprise-wide, providing strategic guidance to CenCal Health Senior Leadership Team and stakeholders, with duties including but not limited to:
  • Collaborating with CenCal Health’s teams, including but not limited to Population Health Management, Medical Management, Member Services, and Quality, to promote the evolution of operational systems aligned with STAR Rating Program goals and CMS requirements.
  • Stay informed and up to date about prospective changes to D-SNP STARS Program measures, reporting requirements and program updates, and communicate requirements to relevant stakeholders to maximize the time to adapt operational systems to changes in D-SNP STARS requirements.
  • Support the development of robust Auditing & Monitoring (A&M) activities to assure complete and accurate data sources and processes necessary to generate reliable source data that complies with CMS D-SNP STARS measure specifications.
  • Promote alignment of organizational processes and strategies with D-SNP STAR Rating Program requirements, and the execution of strategies and tactics to maximize CenCal Health’s STAR ratings.
  • Assure readiness for CMS D-SNP STARS audits, and coordinate, facilitate and ensure timely response to audit findings, including timely development, implementation, and closure of corrective action plans (excludes annual NCQA HEDIS Compliance Audit).
  • Contribute expertise and STARS Program performance insights to multidisciplinary teams to collaboratively plan, deploy, and execute strategies and processes to continuously monitor, achieve, and sustain 5-star ratings.
  • Develop and facilitate training to CenCal Health staff to maximize CenCal Health D-SNP STARS Program readiness.


Education and Experience


Required:

  • Bachelor's degree in Healthcare Administration, Public Health, Nursing, or a related field.
  • Three years of experience with a Medicare STAR Rating Program, including thorough understanding of STARS Program data submission requirements.
  • Four years of experience in a Medicare managed care organization.
  • Three years of experience managing audit relations with regulatory or accrediting bodies (e.g., CMS, NCQA).
  • Must be proficient in creating and preparing reports and presentations.



  • Santa Barbara, United States CenCal Health Full time

    Job SummaryThe Quality Department is committed to preventing disease, ensuring patient safety, and eliminating inequities by improving the quality of care received by members through partnerships with providers and community-based organizations.The Medicare STARS Program Manager is responsible for informing, promoting, and leading the evolution of CenCal...


  • Santa Barbara, United States CenCal Health Full time

    Job SummaryThe Quality Department is committed to preventing disease, ensuring patient safety, and eliminating inequities by improving the quality of care received by members through partnerships with providers and community-based organizations.The Medicare STARS Program Manager is responsible for informing, promoting, and leading the evolution of CenCal...


  • santa barbara, United States CenCal Health Full time

    Job SummaryThe Quality Department is committed to preventing disease, ensuring patient safety, and eliminating inequities by improving the quality of care received by members through partnerships with providers and community-based organizations.The Medicare STARS Program Manager is responsible for informing, promoting, and leading the evolution of CenCal...


  • santa barbara, United States CenCal Health Full time

    Job SummaryThe Quality Department is committed to preventing disease, ensuring patient safety, and eliminating inequities by improving the quality of care received by members through partnerships with providers and community-based organizations.The Medicare STARS Program Manager is responsible for informing, promoting, and leading the evolution of CenCal...


  • United States, CA, Woodland Hills Blue Shield of California Full time

    Your Role   The Senior Director, Risk Adjustment and Medicare STARs role will lead the Medicare Risk Adjustment and Stars programs, two functions that drive appropriate revenue and thus critical to the growth and financially viable and competitive Medicare products. This leader will develop the programs and take accountability by partnering with C-suite...


  • Woodland Hills, CA, United States Blue Shield of California Full time

    Your Role The Senior Director, Risk Adjustment and Medicare STARs role will lead the Medicare Risk Adjustment and Stars programs, two functions that drive appropriate revenue and thus critical to the growth and financially viable and competitive Medicare products. This leader will develop the programs and take accountability by partnering with C-suite...


  • Woodland Hills, CA, United States Blue Shield of California Full time

    Your Role The Senior Director, Risk Adjustment and Medicare STARs role will lead the Medicare Risk Adjustment and Stars programs, two functions that drive appropriate revenue and thus critical to the growth and financially viable and competitive Medicare products. This leader will develop the programs and take accountability by partnering with C-suite...


  • Woodland Hills, CA, United States Blue Shield of California Full time

    Your Role   The Senior Director, Risk Adjustment and Medicare STARs role will lead the Medicare Risk Adjustment and Stars programs, two functions that drive appropriate revenue and thus critical to the growth and financially viable and competitive Medicare products. This leader will develop the programs and take accountability by partnering with C-suite...


  • Woodland Hills, CA, United States Blue Shield of California Full time

    Your Role The Senior Director, Risk Adjustment and Medicare STARs role will lead the Medicare Risk Adjustment and Stars programs, two functions that drive appropriate revenue and thus critical to the growth and financially viable and competitive Medicare products. This leader will develop the programs and take accountability by partnering with C-suite...


  • Melville, NY, United States Senior Services of North America, Inc. Full time

    About Senior Services of North AmericaSenior Services of North America (SSNA), headquartered on Long Island, New York, assists thousands of clients each year with their Medicare coverage options, as well as life insurance and wealth solutions. The agency’s alignment with senior organizations has helped create strong brand awareness within the ever-growing...

  • Director, Medicare

    1 month ago


    United States, CA, Rancho Cordova Blue Shield of California Full time

    Your Role   Reporting to the Sr. Director, Utilization Management, the role of the Director, Medicare & Medi-Cal Utilization Management is critical to the success of Blue Shield of California and the Utilization Management department in realizing its goals and objectives. This individual will play a key role as part of the Utilization Management team in...

  • South Star JCB

    7 days ago


    Fort Worth, TX, United States South Star JCB Full time

    Role – Heavy Equipment Service TechnicianSouth Star JCB is in immediate need of a Heavy Equipment Service Technician to join our growing family in our Fort Worth, TX location. If you would like to work for a company that values its employees and does not treat them as a number, then South Star JCB is the company for you! With highly competitive wages paid...

  • Retail Sales Associate

    2 months ago


    Santa Barbara, California, United States Star MSO, Inc. Full time

    Job SummaryStar MSO, Inc. is seeking a highly motivated and customer-focused Retail Sales Associate to join our team. As a Retail Sales Associate, you will be responsible for providing exceptional customer service, maintaining a clean and organized store environment, and achieving sales goals.Key ResponsibilitiesCustomer Service: Greet and assist customers...


  • Santa Barbara, California, United States Casa Serena Treatment Program for Women Full time

    Casa Serena Treatment Program for Women is seeking a compassionate and innovative individual to join our team as an Overnight Behavioral Health Program Assistant. **About Us** Casa Serena is a residential substance use, mental health, trauma, and eating disorder treatment center for women only. We provide high-quality, integral care in a collaborative...


  • Los Angeles, CA, United States Star Entertainment GmbH Full time

    Star Entertainment seeks an experienced Production Manager to join our dynamic, growing team in developing and producing film music concerts and cultural projects worldwide.About Star EntertainmentFounded in 1999, Star Entertainment is an international production company operating in film, live entertainment, culture, and philanthropy. In film, Star began...


  • Santa Barbara, United States Casa Serena Treatment Program for Women Full time

    Casa Serena is a residential substance use, mental health, trauma and eating disorder treatment center for women only. We are currently looking to add creative, compassionate and innovative individuals to the team in the position of Overnight Behavioral Health Program Assistant!As Santa Barbara's only licensed and accredited treatment program for women, we...

  • Medical Social Worker

    4 weeks ago


    Santa Barbara, California, United States Valle Verde - a HumanGood community Full time

    Medical Social Worker Opportunity at Valle Verde - a HumanGood CommunityWe are seeking a compassionate and skilled Medical Social Worker to join our team at Valle Verde, a HumanGood community. As a Medical Social Worker, you will play a vital role in ensuring the social service needs of our residents are met, and their care plans are developed and...

  • Medical Social Worker

    4 weeks ago


    Santa Barbara, California, United States Valle Verde - a HumanGood community Full time

    Medical Social Worker Opportunity at Valle VerdeValle Verde, a HumanGood community, is seeking a Medical Social Worker to join our team. As a Medical Social Worker, you will play a vital role in ensuring the social service needs of our residents are met.Key Responsibilities:Develop and facilitate resident group activities to meet social and emotional...

  • Medical Assistant

    1 month ago


    Santa Barbara, California, United States Casa Serena Treatment Program for Women Full time

    Casa Serena Treatment Program for WomenWe are seeking a compassionate and skilled Certified Nursing Assistant to join our team at Casa Serena Treatment Program for Women. As a CNA, you will play a vital role in providing high-quality care to our clients in a collaborative and supportive environment.Job SummaryThe Certified Nursing Assistant will be...


  • San Antonio, TX, United States University Health Full time

    POSITION SUMMARY/RESPONSIBILITIES Promotes a population health management approach to health care within a managed health care environment for assigned product lines including STAR Kids, STAR+PLUS, Medicare Advantage and Medicare Advantage Dual Special Needs Plan (D-SNP). Supports Community First's goals to prevent illness, injury, disability and early...