Clinical Quality Stars Program Director

1 day ago


Arlington Heights, Illinois, United States The Health Plan of West Virginia, Inc. Full time
Job Summary

The Clinical Quality Stars Program Manager will play a crucial role in coordinating clinical operations for Medicare Star initiatives and other quality improvement projects. This position will work closely with cross-functional teams to develop quality improvement strategies and maintain a collaborative working relationship with internal departments and external stakeholders.

Key Responsibilities
  • Communicate with the Medical Economics Department and Quality Improvement Departments to obtain ongoing HEDIS and Stars data collections to support and develop SMART goals.
  • Work with internal departments to identify opportunities for improvement, gap closure, and facilitate the development of member and provider clinical data-driven initiatives to promote optimal member outcomes.
  • Create tracking systems for reporting KPIs for the evaluation of activities and the effectiveness related to Medicare Star program initiatives and other performance/quality improvement projects.
  • Using the PDSA cycle, identify barriers and opportunities for improvement related to Star ratings, NCQA, CAHPS, and HOS surveys and other member experience or quality metrics.
  • Collaborate with the Provider Delivery System Department and network provider clinical office staff to execute proper submission of medical records and data needed based on HEDIS specifications.
  • Assist in the development of training and educational material that directly impacts quality initiatives.
  • Participate in quality improvement meetings and committees/subcommittees and focus groups.
Requirements
  • Registered Nurse with an active OH and WV nursing license or the ability to obtain multi-state licensure in OH or WV within 90 days of employment.
  • Minimum of ten years clinical experience with at least five of those years as a Registered Nurse.
  • Minimum of two years of experience related to Medicare Stars, HEDIS, CAHPS, HOS.
  • Minimum of three years of experience in quality improvement PDSA cycle.
  • Minimum of three years in project management experience with demonstrated successful results.
Desired Qualifications
  • CPHQ certification or other quality improvement-driven distinctions.
  • Medicare Star Ratings experience with the ability to analyze and interpret cut-point predictions.


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