Medicare Stars Program Manager

2 weeks ago


New York, New York, United States ProspHire Full time
Job Title: Medicare Stars Manager

As a Consulting Manager at ProspHire, you will be a key leader in our healthcare consulting team, working with health plan clients to improve their quality rating systems and achieve better outcomes. Your expertise in HEDIS/Stars and quality improvement will be essential in developing and implementing strategies to enhance our clients' performance.

Responsibilities:
  • Develop and implement quality improvement programs in accordance with the strategic goals of health plan clients
  • Collaborate with health plan leadership to design and implement processes to measure and collect data for HEDIS/Stars indicators
  • Provide expert guidance on HEDIS/Stars strategy and make recommendations to address areas of concern
  • Manage quality initiatives and work cross-functionally with clinical and technical teams to develop the tools, processes, and reporting required to ensure compliance with a complete and accurate coding and billing function
  • Establish and communicate protocols and standards of care for Medicare Advantage, Medicaid, and ACA member populations
Qualifications:
  • Bachelor's degree in a relevant field required; Master's degree in healthcare or MBA preferred
  • Deep understanding of Medicare, Stars, and HEDIS programs
  • 8+ years' professional experience in Health Plans, Payers, or Government Programs, or a mix of a few years' industry experience combined with consulting at the manager level
  • PMP or Six Sigma Black Belt certification preferred


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