Job Summary:
Manager, Medicare Stars is responsible for building processes and strategy enterprise-wide to support performance improvement across Medicare Quality Measures, including state-specific requirements/measures.
Essential Functions:
- Contributes to leading strategic focus on Stars, MMP withhold and penalty recapture, and other quality rating program initiatives, while driving execution
- Participate and lead efforts to support Pharmacy quality, HEDIS Chart Chase, provider engagement, quality strategy builds, and quality improvement initiatives
- Oversees Quality Improvement and Quality Management activities to meet the regulatory and quality measure requirements for each individual market served
- Responsible with senior leadership for CMS and regulatory reporting monthly, quarterly, and yearly
- Generate and develop monthly reporting, dashboarding, and recommendations based on findings from monitoring measure performance and activities
- Lead tracking and execution of HEDIS Medicare chart chase key quality metrics (Stars and withhold/penalty targets) and participate in roadmap creation to support HEDIS performance. Support enterprise HEDIS team on HEDIS project requirements, including contributing to HEDIS Roadmap creation and implementation
- Conduct monthly and/or quarterly quality reviews with key internal stakeholders, including enterprise/market quality teams, pharmacy teams, and care management
- Support strategy and data needs for meetings with provider groups, pharmacies, and cross functionally to share quality scorecards and discuss improvement initiatives for Medicare Stars and State-specific Quality Measures
- Work cross-functionally with member rewards, pharmacy, care management, consumer experience, health partners, Medicare product, state Quality Improvement, and other teams to identify process gaps and drive improvements
- Analyze and report financial savings related to performance and/or process improvements
- Compile reports and departmental communications, including identifying key differences across state requirements, as well as opportunities for scaling initiatives across states
- Research, define, and establish best practice for advanced programs, initiatives, and interventions to improve quality of care, member experience, Stars ratings and close gaps in care with quality measures for CareSource members
- Build strong working relationships with IT, Provider Relations, Service Operations, Business Partner Services, Case Management, Pharmacy, Medicare Product, other Quality Improvement teams, and any other area in which collaboration will be essential for driving process improvements
- Responsible for team coordination and member outcomes, new staff orientation, training, productivity monitoring, staff development, quality and performance improvement, regulatory and contractual compliance
- Contributes to successful plan performance on Performance/Quality Improvement Plans in accordance with state regulatory bodies and the Centers for Medicare and Medicade Services (CMS)
- Lead building and updating of enterprise and market QI work plans, QIPs, PIPs, and CCIP
- Responsible for maintaining Trilogy documents and assigned sections of Models of Care
- Perform any other job duties as requested
Education and Experience:
- Bachelor's Degree in healthcare field, business administration or related field, or equivalent years of relevant work experience is required
- Masters degree is preferred
- Minimum of five (5) years of Managed care experience is required
- Minimum of three (3) years in quality improvement experience in HEDIS and/or Pharmacy Quality measures required
- Experience in Medicare, Medicaid, and Marketplace quality improvement preferred
- Two (2) years of supervisory/management experience is preferred
Competencies, Knowledge and Skills:
- Intermediate proficiency level of Microsoft Outlook, Word and Excel
- Ability to operate smart phone, iPad, or other mobile communication devices to ensure productivity and ability to perform essential functions
- Ability to communicate effectively with a diverse group of individuals
- Ability to multi-task and work independently within a team environment
- Ability to collaborate with and effectively lead other team members to optimize outcomes for members
- Knowledge of state and federal healthcare environment
- Critical listening and thinking skills
- Decision making and problem-solving skills
- Proper grammar usage
- Strong organizational and time management skills
- Proper phone etiquette
- Customer service oriented
- Training/teaching skills
- Leadership and/or Project/Program Management skills
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
- Flexible hours, including possible evenings and/or weekends as needed
Compensation Range:
$94,100.00 - $164,800.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Salary
Organization Level Competencies
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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