Manager, STARS Member Experience (52646)

GlobalHealth, Inc.; Oklahoma City (OK); On-site; USD 65,000 - 90,000; Full time

Job summary

GlobalHealth, Inc. seeks a quality-focused professional to guide member experience initiatives and ensure NCQA accreditation with a 4+ STAR rating. You will oversee CAHPS surveys, coordinate with provider groups, and develop wellness materials to improve member engagement and health outcomes.

Responsibilities include directing member experience processes, managing CAHPS/HOS vendor performance, and developing Medicare AWV/HRA programs while maintaining PHI confidentiality.

Qualifications

• Bachelor's degree or equivalent experience required.
• 5-years experience in a clinical or health insurance setting required.
• 5-years experience managing data to create reports required.
• Experience in medical quality, marketing, risk adjustment, coding, and/or wellness preferred.
• Requires a valid state Drivers License.

Responsibilities

• Develops, plans, and implements quality member experience initiatives.
• Directs member experience processes to meet NCQA accreditation and 4+ STAR rating.
• Ensures pre-CAHPS surveys are fielded monthly and shares results with external provider groups.
• Builds and maintains relationships with internal departments and external provider groups.
• Implements survey improvement initiatives including CAHPS committee meetings.
• Creates wellness materials for marketing to aid member retention and health improvement.
• Maintains knowledge of HEDIS, CAHPS, HOS, NCQA and CMS measures.
• Manages and monitors performance for CAHPS/HOS survey vendor.
• Develops Medicare AWV/HRA program to increase participation.
• Sets goals for Quality Department toward earning a 4 STAR.
• Creates training material on member experience surveys for staff.
• Maintains confidentiality of PHI per HIPAA and policy.
• Performs other duties as assigned.

Skills

Quality management

Data reporting

CAHPS & NCQA knowledge

HIPAA compliance

Education

Bachelor's degree or equivalent experience

Job description

Who We Are

GlobalHealth is a fast growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long‑term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

Who You Are

Provides guidance, and training to the Quality department and organization‑wide staff that impact member experience improvement initiatives. This position will ensure the effective management of member experience survey ratings, including member and provider outreach.

Essential Job Functions

• Develops, plans, and implements initiatives and other quality member experience improvement strategies, making recommendations for change as needed.
• Directs the member experience processes to ensure the health plan is NCQA-accredited and is a 4+ STAR rating.
• Ensures pre-CAHPS member surveys are fielded on a monthly basis and communicates results with external provider groups.
• Build and maintain relationships with other departments internally, as well as external provider groups, as it relates to STARS and NCQA.
• Implements survey improvement initiatives including CAHPS committee meetings to ensure company-wide involvement to increase member survey scores.
• Creates wellness materials for marketing distribution to aid in member retention and health improvement efforts.
• Maintains an expert technical understanding of HEDIS, CAHPS, HOS, NCQA and Meaningful Use measures set by CMS performance standards.
• Manages and monitors performance for CAHPS/HOS survey vendor.
• Develops and implements Medicare AWV/HRA program to increase provider and member participation.
• Sets actionable and achievable goals for Quality Department implementation toward earning and maintaining a 4 STAR.
• Creates training material on member experience surveys for organization-wide staff.
• Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Performs other duties as assigned

Education And Experience

• Bachelors degree or equivalent experience required
• 5-years experience in a clinical or health insurance setting required
• 5-years experience managing data to create reports required
• Experience in medical quality, marketing, risk adjustment, coding, and/or wellness preferred
• Requires a valid state Drivers License

Knowledge, Skills And Abilities

• Ability to communicate and manage complex working relationships
• Ability to train internal and external parties
• Strong organizational, verbal, written, time management, and telephone skills
• Computer literate and familiar with Microsoft applications (Word, Excel, Outlook)
• Basic electronic health record knowledge and ability to quickly learn new software
• Detailed knowledge of quality performance measures and clinical health care
• Ability to collaborate across departments

Work Environment

This job operates in a clerical, office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. This is a largely sedentary role; however, some filing is required, which would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary. May need to lift to 25lbs.

Travel

Required travel to present Quality survey updates to in‑network provider groups as well as educational conferences for updates on measures or best practices

Supervisory Responsibility

This position has no direct supervisory responsibilities but does serve as a coach and mentor for other positions in the organization that contribute to member experience ratings.

Other Duties

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.