Role Description
Manager, Stars Strategy
Manager II – BPM
Who We Are
UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all.
We have a strong global presence and a dedicated workforce of over 4000 people spread across the world.
Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.
You Are
The role and responsibilities of the Manager- focusing on Quality and Stars Performance is responsible to plan, organize, direct, control, and lead the assigned business unit. This position specializes in running the day-to-day operation for optimizing performance needed to achieve continuous improvement in Stars rating. The role has primary client facing responsibilities and performs within a matrixed, stakeholder partnership environment and should excel in driving synergistic strategies that drive end to end Stars and HEDIS improvement.
The Opportunity
• To promote our client’s mission of helping people live healthier lives and achieve optimum performance in Stars score.
• Leads client Stars initiative execution activities.
• Leads client performance management team.
• Coordinates critical components of our client’s quality management program in compliance with regulatory requirements and NCQA accreditation standards.
• Manager works within highly matrixed relationships to implement and maintain the core infrastructure of quality management program.
• Oversees the implementation of plan quality management components within the client’s market for affiliates and employed medical groups.
• Proactively manages and responds to rapidly changing CMS requirements and environments.
• Collaborates across business segments to attain or maintain the plan's compliance with CMS, NCQA, PQA standards and contractual requirements as they apply to the quality management program (HEDIS, Part D/Patient Safety, and Patient Experience)
• Develops and maintains positive relationships with internal and external stakeholders who impact Stars & HEDIS performance including but not limited to health plan partners within the scope of the quality management program.
• Commands a comprehensive knowledge of risk arrangements, contracts, member, and provider benefit structure.
• Ensures the creation and submission of reports to meet Client and health plan contractual requirements.
• Identifies gaps in patient care and conveys to our client’s offering recommendations for provider and patient engagement for CMS Star Rating
• Prepares presentation and data for reporting to clients.
• Develops strategies for quality improvement opportunities, including Star Measures and HEDIS gap closure and patient experience.
• Maintains and develops strong collaborative relationships with internal and external stakeholders who impact Stars score performance, client payors, network providers/affiliates, vendors, and internal health data teams are producing accurate and complete reporting clients require to assure improved CMS quality program performance.
• Conducts in-depth analyses to target potential interventions or initiatives to improve health plan members quality of care and experience.
• Tracks and reports KPIs and KAIs to achieve improved CMS Star Rating
• Managers others (performance management, guidance, support, assessments, interviews, training)
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
What You Need
• Bachelor's degree in healthcare related field, or comparable experience, master’s degree preferred
• (5) years’ experience in related field with attention to preventative care within government funded health system programs and populations. Three (3+) years supervisory or lead experience in related field required. Bilingual skills preferred.
• 3+ years of experience with demonstrated functional knowledge related to regulatory adherence of a quality management program (HEDIS, Part D/Patient Safety, NCQA, Stars, auditing, reporting, committee management)
• Experience leading Quality teams or similar supervisory experience.
• Experience making formal presentations in front of committees and work group environments and using virtual technology (e.g., Microsoft Teams/Zoom)
• Proficiency in software applications that include, but are not limited to, Microsoft Word, Excel, Outlook, PowerPoint
• Proven solid written and oral communication skills with internal and external partners and employees.
• Effective project management skills in creating, evaluating, and im
Location: Anywhere
Posted: Aug. 21, 2024, 9:59 a.m.
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