Manager, STARS Member Experience (52646)

Globalhealth Holdings; Oklahoma City (OK); Hybrid; USD 70,000 - 100,000; Full time

Job summary

GlobalHealth seeks a dedicated Quality Leader to guide member experience initiatives and ensure NCQA accreditation and a 4+ STAR rating. You will oversee CAHPS and HEDIS related activities, collaborate with cross-functional teams, and drive improvement projects across the organization.

You will develop training materials, manage survey vendors, and maintain confidentiality of PHI in accord with HIPAA. This role requires a Bachelor’s degree and 5+ years in health care quality or insurance

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 Driver's License

Responsibilities

• Develops, plans, and implements initiatives to improve member experience scores.
• Directs member experience processes to support NCQA accreditation and 4+ STAR rating.
• Manages pre-CAHPS surveys and communicates results with provider groups.
• Builds relationships with internal departments and external provider groups on STARS and NCQA.
• Implements survey improvement initiatives and CAHPS committees.
• Creates wellness materials for marketing and member health improvement.
• Maintains knowledge of HEDIS, CAHPS, HOS, NCQA, and CMS measures.

Skills

Communication

Training

Organizational skills

Microsoft Office

EHR knowledge

Quality measures

Education

Bachelor's degree or equivalent

Tools

Microsoft Word

Microsoft Excel

Outlook

EHR systems

Job description

Job Details

Job Location: Any Location Remote US - Oklahoma City, OK 73102

Position Type: Full Time

Education Level: 4 Year Degree

Job Shift: Day

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.