Quality Improvement - QI Stars Specialist_195-2016

Tulsa, OK, USA Req #751 Tuesday, February 18, 2025

JOB SUMMARY:

The Quality Improvement Stars Specialist is an integral part of the team, focusing on enhancing the performance of quality programs. This role requires a proactive individual who is adept at working collaboratively with provider groups and multidisciplinary teams with minimal oversight to ensure adherence to deadlines and compliance with regulatory requirements. The specialist will play a pivotal role in the analysis, development, and implementation of strategies aimed at improving Star Ratings. Included in this is the responsibility for managing and analyzing data from various surveys to drive process improvements and enhance the quality of care for our members.

KEY RESPONSIBILITIES:

• Monitor and analyze Star Ratings performance metrics to identify areas for improvement.

• Develop and maintain detailed reports on Star Ratings performance, trends, and forecasts.

• Plans, organizes, executes, and finishes assigned projects associated with program scope.

• Complies data and prepares reports for other program work related to State, Federal, and Accreditation requirements.

• Develop and maintain strong relationships with provider groups to foster collaboration and engagement in improving quality measures and patient outcomes.

• Coordinate the administration of CAHPS, QHP, and HOS surveys, ensuring timely and accurate data collection and submission.

• Monitor survey processes to maintain high response rates and data integrity.

• Analyze survey data to identify trends, strengths, and areas for improvement.

• Generate reports and dashboards to present findings to stakeholders.

• Present findings to senior management and stakeholders, providing actionable recommendations.

• Provide training and support to provider groups on best practices for achieving high Star Ratings.

• Supports the overall department goals and objectives, including back-up support for various departmental functions.

• Evaluate the effectiveness of quality improvement initiatives and make necessary adjustments.

• Collaborate with cross-functional teams to develop and implement quality improvement initiatives based on survey results.

• Track and evaluate the effectiveness of implemented changes.

• Ensure compliance with all CMS regulations and guidelines related to Medicare Advantage Star Ratings. Keep abreast of changes in Stars Rating program and updates internal processes accordingly.

• Assists with staff orientation, training, and re-training on program work requirements as indicated.

• Perform other duties as assigned.

QUALIFICATIONS:

• Minimum of 3-5 years of experience in healthcare quality improvement or a related role.

• Strong understanding of Medicare Advantage Star Ratings and CMS guidelines.

• Excellent analytical, organizational, and communication skills.

• Ability to work independently and as part of a team.

• Ability to manage multiple tasks simultaneously, work independently with minimal supervision, and meet stringent deadlines.

• Demonstrates strong organizational skills and is attentive to details.

• Possess strong oral and written communication skills.

• Strong familiarity with managed care and healthcare terminology.

• Successful completion of Health Care Sanctions background check.

EDUCATION/EXPERIENCE:

• (Preferred) Bachelor’s degree in healthcare administration, Public Health, Statistics, or a related field.

• Associates degree and/ or 3 years of experience in quality, benefit plans, claims, customer services, quality improvement, medical management, or similar healthcare operations.

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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