Stars Program Manager

2 weeks ago

Tulsa, Oklahoma, United States CommunityCare Full time

Job Overview:

The Stars Program Manager will be responsible for leading and enhancing the health plan's initiatives to achieve superior star ratings for Medicare and Marketplace-related services. This role involves strategizing and translating organizational goals into actionable plans within a collaborative framework. The focus on quality activities is paramount, constituting 100% of the responsibilities.

PRIMARY DUTIES:

  • Collaborate with various departments and provider leadership to formulate and implement the Stars strategy.
  • Direct the strategic and operational efforts to enhance member satisfaction and provider engagement in HEDIS.
  • Steer the creation and execution of essential Stars strategy projects that are vital for the organization's success in attaining optimal clinical outcomes and star rating objectives.
  • Ensure comprehensive documentation aligns with regulatory and accreditation requirements.
  • Promote adherence to best practices while innovating in partnership with internal and external stakeholders to boost member and provider participation.
  • Examine and interpret data from diverse sources to uncover trends, assess effectiveness, proactively address complex challenges, mitigate risks, and formulate plans for ongoing enhancement across HEDIS, CAHPS, and Pharmacy metrics.
  • Lead special initiatives with cross-functional teams and senior management to meet strategic performance targets.
  • Work in close coordination with data analysts to establish and oversee targeting and monitoring systems.
  • Prepare content for leadership discussions, structure presentations, equip speakers, and anticipate critical issues and data necessary for constructive dialogue.
  • Identify and articulate data requirements essential for resolving business challenges; evaluate analytical results, test relevance and applicability, and extract key insights.
  • Stay informed about current and emerging Federal/State regulations affecting star ratings; lead program updates as necessary and integrate them into operational processes.

REQUIREMENTS:

  • Exceptional written, verbal, and presentation abilities.
  • Strong analytical capabilities.
  • Interpersonal skills to foster relationships and advance Stars objectives.
  • Proficiency in Microsoft Office applications.
  • Successful completion of a Health Care Sanctions background check.

EDUCATION AND EXPERIENCE:

  • Bachelor's Degree in Nursing, Business, Finance, Healthcare, or a related field; a Master's Degree in a healthcare discipline (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, both direct reports and within a matrixed structure.
  • Experience in project management and process improvement is preferred.

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