Description

Under the direction of the Director of Quality Improvement and Grievance and Appeals, the Stars Program Manager supports the Medicare Special Needs Plan (SNP) Stars program. This is through alignment of internal stakeholders and external stakeholders to develop, execute and monitor a comprehensive star strategy for the SNP product line. The Program Manager leads the identification, design and implementation of company-wide quality improvement initiatives through cross-functional work teams in support of Stars performance and to attain the highest-level performance.

Duties and Responsibilities:

Responsibilities include, but are not limited to, the following:

• Establish and lead the operational work plans for the Stars Program including the identification of risks and potential mitigation plan
• Lead the development of Stars related data strategy including the development and implementation of dashboards
• Monitor the Stars performance through ongoing analysis of data and find opportunities for improvement for all measures in the program. Work collaboratively across the organization to ensure gap in performance are addressed
• Conduct ongoing evaluation of initiatives implemented and makes recommendations based on the evaluation
• Use evidence-based and multi-component approaches to program strategy, design, and execution
• Lead cross-functional inter-departmental team which plans, organizes, coordinates and identifies improvement opportunities in support of achievement of highest level of Stars Rating
• Lead efforts in obtaining the highest pay for performance incentive awards in the Stars program, including the identification of potential risks in achieving the highest level of performance
• Collaborate with internal and external stakeholders on provider-based strategies to support Stars performance
• Responsible for assuring that the annual Stars Rating data and the information on performance are analyzed and disseminated to help identify high-priority improvement and innovation opportunities for the organization
• Serve as the subject matter expert on Medicare Stars program including all aspects of the technical specifications
• Maintain strategic relationships and partner with key resources, both internal and external, to support the design and ensure market, member, and provider considerations are factored into the design. May include vendor oversight
• Maintain current knowledge of all present and future quality mandates from regulatory bodies including NCQA, Executive Office of Health and Human Services, Centers for Medicare and Medicaid Services and other regulatory bodies
• Coach, mentor, motivate, and provide oversight to project team members and influence them to take positive action and accountability for their assigned work
• Perform other duties as assigned.
• Corporate Compliance Responsibility - As an essential function, responsible for complying with Neighborhood’s Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, policies and procedures as it applies to individual job duties, the department, and the Company. This position must exercise due diligence to prevent, detect and report unlawful and/or unethical conduct by fellow co-workers, professional affiliates and/or agents.
  
  
  

Qualifications

Qualifications

Required:

• Bachelor’s degree, preferably in business administration, health care administration, public health or related field. In lieu of a degree, previous experience greater than five (5) years managing a Stars program.
• Five (5) or more years’ of experience in health care managing a Medicare Stars program with ability to drive performance.
• Knowledge and experience in data collection, technical specifications, and key performance drivers of all Stars measures
• Ability to work with and present results to high level internal and external entities, such as senior leaders, provider groups and state regulatory entities
• Experience leading workgroups, designing quality improvement initiatives
• Strong program/project management, analytical, planning, and goal-setting skills. Including process improvement and change management
• Ability to develop and implement detailed project plans, including handling multiple projects simultaneously in a deadline driven environment
• Experience working with a multi-disciplinary team, multiple collaborators and communicating with all levels of various organizations
• Proven ability to handle various assignments in a fast-paced and complex business environment.
• Strong organizational and documentation skills
• Strong team building, coaching and leadership skills
• Solid time management and organizational skills
• Ability to work autonomously and independently
• Excellent customer service orientation
• Intermediate to Advanced skills in Microsoft Office (Project, Word, Excel, PowerPoint, Outlook)
  
  
  

Preferred:

• Master’s degree in business administration, public health or related field
• Knowledge of Risk Adjustment data validation (RADV)
• National Association of Healthcare Quality certification as a Certified Professional in Healthcare Quality/Organizational Excellence (CPHQ/OE) or similar QI training
  
  
  

Neighborhood Health Plan of Rhode Island is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.