Medicare Star Quality Improvement Specialist

Health Plan; Wheeling (WV); On-site; USD 60,000 - 85,000; Full time

Job summary

The Health Plan is seeking a Quality Stars Program Coordinator in Wheeling, WV to focus on Medicare Star initiatives and other quality projects, interfacing with Clinical Services, Pharmacy, Quality Improvement and Medical Economics to drive outcomes.

The role involves data analysis, trend identification, member/provider outreach, and support for provider education; requires collaboration across departments and use of PDSA cycle to improve star ratings.

Qualifications

• Bachelor’s degree or equivalent healthcare industry experience (five years).
• Experience in Managed Care, Medicare Stars, HEDIS, CAHPS, HOS required.
• Ability to prioritize with minimal supervision.
• Ability to build working relationships with internal staff and external stakeholders.

Responsibilities

• Learn and apply Medicare Part C&D Star Ratings Technical Notes with leadership.
• Coordinate data collection and reporting to support SMART goals.
• Identify opportunities for improvement and drive data‑driven initiatives.
• Track KPIs and assist to evaluate program effectiveness.
• Collaborate with Provider Operations and Provider Experience teams for education.
• Use PDSA cycles to identify barriers and opportunities for improvement.
• Develop training materials impacting quality initiatives.
• Participate in quality improvement meetings and focus groups.

Skills

Data analysis

Reporting

Medicare Stars

HEDIS

CAHPS

HOS

Education

Bachelor's degree or equivalent healthcare industry experience

Job description

The Health Plan is seeking a Quality Stars Program Coordinator in Wheeling, WV to focus on Medicare Star initiatives and other quality projects, interfacing with Clinical Services, Pharmacy, Quality Improvement and Medical Economics to drive outcomes.

The role involves data analysis, trend identification, member/provider outreach, and support for provider education; requires collaboration across departments and use of PDSA cycle to improve star ratings.