Medicare STARS Program Manager

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive.  This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

•    Integrity

•    Accountability

•    Collaboration

•    Trust 

•    Respect

Disclaimers:

•    Flexible work schedule is based on job duties, department, organization, or business need.

•    Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Medicare STARS Program Manager is responsible for informing, promoting, and leading the evolution of Gold Coast Health Plan’s (GCHP) managed care systems to maximize quality as measured by the Centers for Medicare and Medicaid Services (CMS) 5 STAR Rating System.

Reporting to the Senior Director of Quality Improvement, the Medicare STARS Program Manager plays a pivotal role to strategically optimize operational initiatives plan wide to maximize GCHP’s Duals Special Needs Plan (D-SNP) STAR ratings, and to elevate GCHP’s Medicare STAR Rating Program governance.

The successful candidate is a subject matter expert (SME) in regulations that govern the CMS Medicare D-SNP STAR Rating System, and in the application of operational strategies and tactics to maximize Star Rating System outcomes. The Senior Quality Improvement Program Manager will serve as a high-level individual contributor.

Amount of Travel Required: 5-10%

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

•    Sustained up-to-date D-SNP STARS System subject matter expertise of significant complexity, understanding of the present and future operational impacts of changes to STAR Rating Program requirements.

•    Ability to clearly communicate STAR Rating System requirements and their impacts to operational systems enterprise-wide; collaboration with cross-functional teams to build an understanding of the intersection between STAR Rating requirements and the operational excellence required to achieve exceptional member experience and outcomes.

•    Subject Matter Expertise liaison to stakeholders’ enterprise-wide to provide strategic guidance to support and promote process deployment, refinement, and execution to maximize STAR ratings.

Collaborate with cross-functional teams to drive systems improvement to maximize STAR measure ratings, with duties including but not limited to:

•    At least annually develop Gold Coast Health Plan’s (GCHP) STAR Rating Program strategic objectives as a component of the Quality Improvement and Health Equity Transformation Program (QIHETP) Work Plan, and in congruence with the Population Health Management Strategy, and Operating Plan. Update STAR Rating Program strategic objectives quarterly in congruence with emerging requirements and priorities.

•    Own relationship with and optimize use of vendor STARS applications, and design and implement solutions in collaboration with cross-functional stakeholders and the Information Technology Division, to monitor performance relative the STAR Rating Program goals and enable effective STAR Rating Program governance.

•    Cultivate and sustain mutually beneficial partnerships with vendors that provide systems to monitor and manage STARS performance.

•    Monitor, track, and communicate STARS-related Key Performance Indicator (KPI) outcomes, to demonstrate and elevate the effectiveness of the plan’s STAR Rating Program.

•    Oversee the preparation and filing of the measures included in the CMS STAR Rating Program and maintain reports and back up information to review preliminary measure results to ensure the accuracy of the STAR Rating Program information.

Serve as a SME and resource enterprise-wide, providing strategic guidance to GCHP’s Senior Leadership Team and stakeholders, with duties including but not limited to:

•    Collaborating with GCHP’s teams, including but not limited to Population Health Management, Medical Management, Member Services, and Quality, to promote the evolution of operational systems aligned with STAR Rating Program goals and CMS requirements.

•    Stay informed and up to date about prospective changes to D-SNP STARS Program measures, reporting requirements and program updates, and communicate requirements to relevant stakeholders to maximize the time to adapt operational systems to changes in D-SNP STARS requirements.

•    Support the development of robust Auditing & Monitoring (A&M) activities to assure complete and accurate data sources and processes necessary to generate reliable source data that complies with CMS D-SNP STARS measure specifications.

•    Promote alignment of organizational processes and strategies with D-SNP STAR Rating Program requirements, and the execution of strategies and tactics to maximize GCHP’s STAR ratings.

•    Assure readiness for CMS D-SNP STARS audits, and coordinate, facilitate and ensure timely response to audit findings, including timely development, implementation, and closure of corrective action plans (excludes annual NCQA HEDIS Compliance Audit).

•    Contribute expertise and STARS Program performance insights to multidisciplinary teams to collaboratively plan, deploy, and execute strategies and processes to continuously monitor, achieve, and sustain 5-star ratings.

•    Develop and facilitate training to maximize GCHP’s D-SNP STARS Program readiness.

•    Attend stakeholder meetings as requested.

•    Other duties as assigned.

MINIMUM QUALIFICATIONS

Education & Experience:

•    Bachelor's Degree in a related discipline such as healthcare or data analytics

•    At least five years of experience in Medicare Advantage 5 Star health care quality improvement, health care administration, performance measurement with demonstrated outcomes improvement track record

•    Experience creating and implementing health interventions and tracking outcomes

•    Experience in completing efficient analysis of data with associated conclusions and recommendations for improvement

•    Excellent verbal and written communication skills with the ability to present complex information in a simplified easy to understand manner

•    Knowledge of all MS Office applications, including Word, Excel and PowerPoint

•     Strong verbal communication skills and ability to effectively engage with diverse stakeholders

•    Strong analytic and critical thinking skills and ability to think creatively

•    Strong written communication skills including the ability to produce well-organized and informative reports

•    Experience working with industry and consumer stakeholder groups

Equivalent In lieu of degree:   

Will accept experience in any combination of academic education, professional training, or work experience, which demonstrates the ability to perform the duties of the position.

KNOWLEDGE, SKILLS & ABILITIES   

Preferred Qualifications:    

•    Master’s degree in related disciplines

•    Advanced experience in data analytics as well as software tools utilized in the process of analyzing healthcare data

•    Experience with Microsoft Access or equivalent database software

•    Advanced experience with quality-of-care measurement tools such as HEDIS, HOS< and CMS Star Ratings

•    Experience with healthcare claims data

•    Comfortable with presenting in front of leadership   

Technology & Software Skills: Advanced computer skills in MS Office products.

Certifications & Licenses: A valid and current Driver's License, Auto Insurance, and professional licensure(s) required

Competency Statements

•    Management Skills - Ability to organize and direct oneself and effectively supervise others.

•    Business Acumen - Ability to grasp and understand business concepts and issues.

•    Decision Making - Ability to make critical decisions while following company procedures.

•    Goal Oriented - Ability to focus on a goal and obtain a pre-determined result.

•    Interpersonal - Ability to get along well with a variety of personalities and individuals.

•    Diversity Oriented - Ability to work effectively with people regardless of their age, gender, race, ethnicity, religion, or job type.

•    Time Management - Ability to utilize the available time to organize and complete work within given deadlines.

•    Consensus Building - Ability to bring about group solidarity to achieve a goal.

•    Relationship Building - Ability to effectively build relationships with customers and co-workers.

•    Presentation Skills - Ability to effectively present information publicly.

•    Delegating Responsibility - Ability to allocate authority and/or task responsibility to appropriate people.

•    Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions.

•    Strategic Planning - Ability to develop a vision for the future and create a culture in which the long-range goals can be achieved.

•    Ethical - Ability to demonstrate conduct conforming to a set of values and accepted standards.

•    Judgment - The ability to formulate a sound decision using the available information.

•    Communication, Oral - Ability to communicate effectively with others using the spoken word.  

•    Communication, Written - Ability to communicate in writing clearly and concisely.  

•    Problem Solving - Ability to find a solution for or to deal proactively with work-related problems.