CMS 5 Star Program Manager

2 weeks ago

Worcester, United States Fallon Health Full time

Overview:

About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nations top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

Brief Summary of Purpose:

Principle responsibility of the Medicare 5 star Program Manager is to collaborate with Fallon Healths 5 Star owner to produce dashboards, trend and surveillance reports for senior management and department leaders and teams, tracking individual metric measure and executed intervention performance. This includes, a thorough performance review of end-to-end process across all Stars measures, inclusive of KPI identification, accountability tracking and review as well as oversight of all LOB activities and plans. Additionally this role will work with business areas to design, develop, modify and test reports to support business needs and transaction management in support of Fallons 5 star rating goals. This includes engaging leaders and business owners to help define, shape and drive Stars performance. The analyst will leverage their analytic skill set and experience with large health care data sets to identify and communicate trends as well as prioritize and recommend improvements through data-driven analysis. The Medicare 5 star Program Manager will also be responsible for investigating specific areas of concern with 5 star performance. The objective of the Medicare 5 star Program Manager activities is to qualify Fallon Health performance with real time date with the goal of creating actionable activities to improve performance. It is also expected that this role proactively identifies and addresses scalability and performance bottlenecks to support efficiencies. They are consultative to the business and accountable for the quality and effectiveness of the data in the subject area across all related systems (QNXT, data warehouse) and are expected to be subject matter experts for this data.

Responsibilities:
  • Produce dashboards, trend and surveillance reports for senior management and department leaders and teams, tracking individual measure and interventions performance. Dashboard reports are based on real time cross sectional segments.
  • Analyzes and supports data analytics to easily identify Medicare Star measures for cultural trends (demographics, disparities and social determinants), operational inefficiencies and
  • provider practice patterns
  • Reviews current reports and outputs for accuracy, efficiency and viability
  • Gathers business requirements; determines most effective and efficient reporting platform
  • Review logic, criteria and definitions to incorporate into data models to extract functional data sets for reporting
  • Work closely with resources to develop outputs based on gathered requirements
  • Develops alternative techniques for gathering a variety of data that is not available from established sources
  • Assist in the identification of trends that impacts 5 Star ratings
  • Leverages mathematical calculations to determine integrity of data samples
  • Evaluates risks; collects statistical information to determine whether business areas have negative impacts on their businesses, or at least improve their business practices,
  • Consultative to business owners to applying analytical findings to the business.
  • Actively participate analyst meetings
  • Identifies improvements regarding report efficiencies and platform effectiveness
  • Works with business owners to research root cause and communicate improvement recommendations
  • Participates in continuing education activities to improve upon skills
  • Support design and execution of analytical roadmap in collaboration with organizational 5 star owner and domain experts to drive delivery of analytical projects that support relevant, actionable business insights.
  • Work collaboratively with Director and business owners
  • Provides assistance on technical matters and act as a significant information resource
  • Participant in cross functional initiatives


Qualifications:

Bachelor Degree at a minimum; Advanced education preferred in health-related related field such as healthcare management or healthcare informatics; PMP and/or Six sigma a plus

SSMS (SQL Server Management Studio), Crystal Reports (if applicable), Business Objects / Web Intelligence, MS Visio, MS Office, other applications (SAS To be evaluated) a plus.

  • Research Program Manager II

    1 week ago

    Worcester, United States InsideHigherEd Full time

    OverviewGENERAL SUMMARY OF POSITION:  Under the general direction of the Principal Investigator or designee, the Research Program Manager II manages the day-to-day operations of short term and multi-year research projects. The Research Program Manager II is responsible for the implementation of research projects from inception to completion and manages and...

  • Research Program Manager I

    2 weeks ago

    Worcester, United States InsideHigherEd Full time

    OverviewGENERAL SUMMARY OF POSITION:  Under the general direction of the Principal Investigator or designee, the Research Program Manager I is responsible for managing the day-to-day operations of NIH or other externally funded, large scale projects. The Research Program Manager will collaborate with investigators, consultants, project directors, and...

  • Hcc Coder

    4 weeks ago

    Worcester, United States UMass Memorial Health Care Full time

    Schedule Details: Monday through Friday Scheduled Hours: 7:30 Shift: 1 - Day Shift, 8 Hours (United States of America) Hours: 40 This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process. Everyone Is a Caregiver At UMass Memorial Health, everyone is a caregiver - regardless...

  • Program Director, Crozier Men's Recovery Program

    3 weeks ago

    Worcester, United States Catholic Charities Diocese Of Worcester Inc Full time

    Job DescriptionJob DescriptionDescription:This individual will provide leadership and be responsible for the administration, coordination and development of Crozier House, including the men’s three-quarter house program. Responsibilities include overseeing the operation and management as dictated by state contract and guidelines of the Department of Public...

  • Research Program Manager II

    2 weeks ago

    Worcester, Massachusetts, United States University of Massachusetts Medical School Full time

    Overview: GENERAL SUMMARY OF POSITION:  Under the general direction of the Principal Investigator or designee, the Research Program Manager II manages the day-to-day operations of short term and multi-year research projects. The Research Program Manager II is responsible for the implementation of research projects from inception to completion and manages...

  • Program Director, Mercy Centre

    1 month ago

    Worcester, United States Catholic Charities Diocese Of Worcester Inc Full time

    Job DescriptionJob DescriptionDescription:Mercy Centre is a program of Catholic Charities located in Worcester, Massachusetts. Founded by the Sisters of Mercy and Catholic Charities in the 1960’s, the program serves over one hundred adults with developmental disabilities ages eighteen and over in four different programs from the Worcester County extended...

  • Program Coordinator

    3 weeks ago

    Worcester, United States Biomedical Research Models Full time

    Job DescriptionJob DescriptionGENERAL SUMMARYThe Program Coordinator provides leadership along with the oversight and daily supervision of day-to-day operations of the assigned area including supervision of assigned tasks. Program Coordinators are proficient in required tasks and work to ensure that tasks and studies in the assigned area are being performed...

  • Research Program Manager I

    4 weeks ago

    Worcester, Massachusetts, United States University of Massachusetts Medical School Full time

    Overview: GENERAL SUMMARY OF POSITION:  Under the general direction of the Principal Investigator or designee, the Research Program Manager I is responsible for managing the day-to-day operations of NIH or other externally funded, large scale projects. The Research Program Manager will collaborate with investigators, consultants, project directors, and...

  • Residency Program Coordinator II

    2 weeks ago

    Worcester, United States University of Massachusetts Medical School Full time

    Overview GENERAL SUMMARY OF POSITION: Under the general supervision of the Residency Program Director or designee, the Residency Program Coordinator II is responsible for the coordination of a wide range of diverse administrative functions for one or more residency/fellowship programs and may also be responsible for medical student elective clerkships in...

  • Program Manager Home Health

    4 weeks ago

    Worcester, United States Boston Healthcare Management Llc Full time

    Job DescriptionJob DescriptionWe are seeking a Program Manager Home Health to join our team! You will be responsible for the assessment, diagnosis, and treatment of assigned patients.Responsibilities:Administer nursing care to ill, injured, or disabled patientsDiagnose and establish patient treatment plansMonitor and report changes in patient symptoms or...

  • Residency Program Coordinator II

    3 weeks ago

    Worcester, United States University of Massachusetts Medical School Full time

    Overview: GENERAL SUMMARY OF POSITION: Under the general supervision of the Residency Program Director or designee, the Residency Program Coordinator II is responsible for the coordination of a wide range of diverse administrative functions for one or more residency/fellowship programs and may also be responsible for medical student elective clerkships in...

  • Quality Improvement Director

    1 month ago

    Worcester, United States Saint Vincent Hospital Full time

    **Saint Vincent Hospital** offers a whole new experience in health care. By combining our advanced, state-of-the-art facility with our commitment to providing the best quality of life to the many members of our Worcester community. Saint Vincent Hospital excels at offering the best care in a friendly atmosphere. From our advanced heart and vascular services,...

  • Clinical Supervisor Crozier Men's Recovery Program

    3 weeks ago

    Worcester, United States Catholic Charities Diocese Of Worcester Inc Full time

    Job DescriptionJob DescriptionDescription:This individual will be responsible for the development, implementation and evaluation of all educational programs within the Crozier House men's recovery home program. This position will also assist the Program Administrator on the development and implementation of program standard, while providing both direct...

  • Program Director, Crozier Men's Recovery Program

    2 weeks ago

    Worcester, United States Catholic Charities Diocese Of Worcester, Inc. Full time

    This individual will provide leadership and be responsible for the administration, coordination and development of Crozier House, including the mens three-quarter house program. Responsibilities include overseeing the operation and management as dic Program Director, Program, Recovery, Director, Healthcare

  • Academic Success Program Director

    4 days ago

    Worcester, United States Boys & Girls Club of Worcester Full time

    **The Boys & Girls Club of Worcester is a nonprofit, charitable, educational organization recognized as a leading advocate for youth development, working to help youth of all backgrounds.** Come make a difference with us! Our history and our mission is this: Boys & Girls Clubs of Worcester serves over 500 kids from 5 to 18 years of age daily. We are a...

  • Production Manager

    1 month ago

    Worcester, Massachusetts, United States Affinity Full time

    Come join an exciting organization going through some change and growth. We are seeking a motivated Manufacturing Production Manager to lead production operations, track and improve on metrics, lead safety and be responsible for the execution of the quality program on the plant floor (not to be confused with the Quality Manager). The team is between with...

  • Academic Advisor

    6 days ago

    Worcester, United States Quinsigamond Community College Full time

    **Location**:Worcester, MA **Category**:Professional **Posted On**:Sun May 12 2024 **General Statement** The Academic Advisor position, which is housed within the Academic Advising Center, is responsible for providing proactive advising to assigned students. The position will ensure that first time, at-risk, first generation, and low-income students are...

  • Project Coordinator, 40 Hour, Days

    5 days ago

    Worcester, United States UMass Memorial Health Care Full time

    Exemption Status: Non-Exempt Schedule Details: Monday through Friday Scheduled Hours: 8:30AM - 5:30PM Shift: 1 - Day Shift, 8 Hours (United States of America) Hours: 40 Cost Center: 10030 - 6220 Patient Experience This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview...

  • Residential Program Director

    2 weeks ago

    Worcester, United States Venture Community Services, Inc. Full time

    Are you empathetic, compassionate, teamwork oriented, and looking for a position with growth opportunity? Do you enjoy helping others and having the opportunity to make a difference in someones life? This position is perfect for you! We are seeking Program Director, Residential, Director, Program, Business Services, Manager

  • Program Services Coordinator

    4 weeks ago

    Worcester, United States Sevita Full time $42,000 - $44,000

    We seek a passionate Case Manager who can successfully implement and monitor individual service plans.Job Details:This position supports individuals we serve in Shared Living/Adult Foster Care settings in Massachusetts.In this role, you will provide case management services for the individuals we serve in our Shared Living/Adult Foster Care Program with the...