Clinical Quality Stars Program Director

4 weeks ago

Wheeling WV, United States The Health Plan of West Virginia, Inc. Full time

Job Summary: We are seeking a highly skilled Clinical Quality Stars Program Manager to join our team at The Health Plan of West Virginia, Inc. This role will coordinate clinical operations for Medicare Star initiatives and other quality improvement initiatives.

Key Responsibilities:

  1. Collaborate with internal departments to identify opportunities for improvement and develop member and provider clinical data-driven initiatives.
  2. Communicate with the Medical Economics Department and Quality Improvement Departments to obtain ongoing HEDIS and Stars data collections.
  3. Develop and implement tracking systems for reporting KPIs and evaluating the effectiveness of Medicare Star program initiatives.
  4. Assist in the development of training and educational materials that impact quality initiatives.
  5. Participate in quality improvement meetings and committees.

Requirements:

  1. Registered Nurse with an active OH and WV nursing license or the ability to obtain multi-state licensure within 90 days.
  2. Minimum of ten years clinical experience with at least five years as a Registered Nurse.
  3. Minimum of two years of experience related to Medicare Stars, HEDIS, CAHPS, and HOS.
  4. Minimum of three years of experience in quality improvement PDSA cycle.
  5. Minimum of three years in project management experience with demonstrated successful results.

Desired Qualifications:

  1. CPHQ certification or other quality improvement driven distinctions.
  2. Medicare Star Ratings experience with the ability to analyze and interpret cut point predictions.

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