Quality Improvement - Manager STARS 195-5003

Tulsa, OK, USA Req #595 Wednesday, August 21, 2024

JOB SUMMARY:

The Stars Manager will oversee and drive the health plan to achieve optimal star ratings for Medicare and Marketplace related product lines. The Stars Manager will assist in developing strategy and translate strategy and goals into execution within a matrixed organizational environment. Overall percentage of responsibilities pertaining to quality activities for this job role is 100%.

KEY RESPONSIBILITIES:

• Work across the health plan and with provider leadership to develop and execute Stars strategy
• Lead the strategy and tactical direction to improve member experience and provider HEDIS engagement
• Drive the development and execution of high-priority Stars strategy initiatives critical to the company’s success of achieving top clinical outcomes and Star rating targets
• Maintain effective documentation to meet regulatory and Accreditation Standards
• Ensure that best practices are followed and develop innovative approaches in collaboration with internal and external stakeholders to improve member and provider engagement
• Analyze and interpret data from multiple data sources to identify trends, evaluate efficacy, proactively solve complex problems, remediate risks, and develop plans to drive continuous improvement across HEDIS, CAHPS and Pharmacy measures
• Lead special projects with cross-functional teams and senior leaders to achieve strategic performance goals
• Work closely with data analysts to develop and manage targeting and monitoring capabilities
• Develop content for leadership review, structure decks, prepare speakers, anticipate key issues and questions and data needed to drive productive discussion
• Identify and articulate data needs required to assist with solving business problems; evaluate analytical outputs, testing relevance and applicability and identify key insights
• Stay abreast of and keep the organization appraised of existing and new Federal/State issues impacting Star ratings; lead program updates as needed and incorporate into work programs and processes
  
  

QUALIFICATIONS:

• Excellent written, verbal, and presentation skills.
• Excellent analytical skills.
• Interpersonal skills to create relationships, and advance STARS objectives.
• Proficient in Microsoft Office applications.
• Successful completion of Health Care Sanctions background check.
  
  

EDUCATION/EXPERIENCE:

• Bachelor’s Degree in Nursing, Business, Finance, healthcare or related field. Master’s Degree preferred in a healthcare field (MPH, MSN, MHA)
• CPHQ preferred
• Five or more years of business experience in healthcare or healthcare insurance required; Medicare experience preferred.
• Five or more years’ experience in managing teams, both direct reports and in a matrixed environment
• Project management and process improvement experience preferred.

CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Other details

• Job Family Commercial
• Pay Type Salary

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