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Medicare Quality Improvement Manager
2 months ago
Position Overview:
The Stars Program Manager will lead initiatives to enhance the health plan's performance in achieving superior star ratings for Medicare and Marketplace product lines. This role is pivotal in shaping strategic direction and translating objectives into actionable plans within a collaborative organizational framework. The focus of this position is entirely on quality-related activities.
PRIMARY DUTIES:
- Collaborate with various departments and provider leadership to formulate and implement the Stars strategy.
- Direct efforts to enhance member satisfaction and provider engagement in HEDIS measures.
- Steer the creation and execution of essential Stars strategy initiatives that are vital for the organization’s success in attaining optimal clinical outcomes and star rating goals.
- Ensure compliance with regulatory and accreditation standards through meticulous documentation.
- Promote adherence to best practices while fostering innovative solutions in partnership with internal and external stakeholders to boost member and provider involvement.
- Evaluate and interpret data from diverse sources to uncover trends, assess effectiveness, proactively address complex challenges, mitigate risks, and formulate plans for ongoing improvement across HEDIS, CAHPS, and Pharmacy metrics.
- Lead cross-functional projects with senior leadership to meet strategic performance objectives.
- Work in tandem with data analysts to establish and oversee targeting and monitoring systems.
- Prepare comprehensive materials for leadership discussions, including structured presentations, speaker preparations, and anticipating critical issues and necessary data for productive dialogues.
- Identify and clarify data requirements essential for resolving business challenges; assess analytical outputs for relevance and applicability, and extract key insights.
- Stay informed about existing and emerging Federal/State regulations affecting star ratings; lead program updates as necessary and integrate them into operational workflows.
REQUIREMENTS:
- Exceptional written, verbal, and presentation capabilities.
- Strong analytical acumen.
- Interpersonal skills to cultivate relationships and advance Stars objectives.
- Proficiency in Microsoft Office Suite.
- Successful completion of a healthcare sanctions background investigation.
EDUCATION AND EXPERIENCE:
- Bachelor's Degree in Nursing, Business, Finance, Healthcare, or a related discipline; a Master's Degree in a healthcare field (MPH, MSN, MHA) is preferred.
- Certification in Professional Healthcare Quality (CPHQ) is preferred.
- A minimum of five years of experience in the healthcare or health insurance sector is required; experience with Medicare is preferred.
- At least five years of experience in team management, including direct reports and within a matrixed environment.
- Experience in project management and process enhancement is preferred.
