Quality Program Manager - Health Plan Medicare Advantage Stars *Remote*

Providence; Beaverton (OR); Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare organization seeks a Quality Program Manager for their Medicare Advantage Stars initiative. The role involves driving improvements in Star Ratings through data-driven interventions and collaboration with various departments. Ideal candidates should have a degree in public health or a related field, along with significant project management experience and a strong understanding of the Medicare Advantage Stars program.

Qualifications

• 3+ years of experience in managed care or clinical setting.
• 3+ years of project or program management experience.
• Experience in program planning, development, and evaluation.

Responsibilities

• Develop best-practice interventions for Star Ratings.
• Utilize reports to identify improvement opportunities.
• Collaborate with departments for Stars initiatives.

Skills

Project management skills

Understanding of Medicare Advantage Stars

Collaboration skills

Data analysis

Education

Bachelor's or Master's Degree in Public Health or related field

Job description

Description

Quality Program Manager - Health Plan Medicare Advantage Stars Remote

The Quality Program Manager Health Plan Medicare Advantage Stars is tasked with serving as a health plan Star Ratings Subject Matter Expert (SME) who is experienced at using Stars data, CMS Star Rating Technical Notes and HPMS memos to develop and implement best-practice interventions that result in improved Star ratings.

The Health Plan Medicare Advantage Stars Quality Program Manager will:

• Develop and implement best-practice interventions to improve Medicare Advantage Star Ratings, driving clinical quality indicators (HEDIS Star metrics), CAHPS, and HOS efforts.
• Utilize reports and dashboards to identify and socialize Star rating trends, gaps, and areas for improvement and use the data to develop action and monitoring plans.
• Collaborate with various health plan departments (care management, customer service, outreach, product, sales, marketing, etc.) to develop and implement best-practice Stars initiatives that result in improved ratings.
• Ensure compliance with CMS Stars deliverables (e.g.: plan previews, final HEDIS, CAHPS, HOS results) and keep abreast of changes affecting Star Ratings (e.g.: measure changes, weights, cut points).
• Monitor and report on Stars program performance, delivering insights, interventions, impact to workgroups, committees, executives.
• Develop and manage relationships with external partners, stakeholders, vendors involved in Stars initiatives.
• Demonstrate strong project management skills, capable of organizing, facilitating, and managing multiple projects and programs simultaneously.
• Fully understand health plan operations and levers that result in Medicare Advantage Stars improvement. Health plan Medicare Stars experience, and understanding is critical in this role.

Providence welcomes virtual work for applicants who reside in one of the following States:

• Washington
• Oregon

Required Qualifications:

• Bachelor's Degree -OR- Master's Degree in Public Health, Business Administration, Health Science, Health Services Administration, or other healthcare or business-related field -OR- a combination of equivalent education and work experience
• 3 or more years of related experience working in, or with a managed care organization or clinical setting in a managed care environment
• 3 or more years of experience in project management or program management
• Demonstrated experience in program planning, development, and evaluation

Preferred Qualifications:

• Experience in quality management principles, tools, and techniques
• 5 or more years of experience in project management or program management
• Experience with Stars program oversight, including intervention development and implementation for clinical quality (Stars HEDIS) measures, CAHPS, HOS
• Deep understanding of the Medicare Advantage Stars program, CMS Star Rating Technical Notes, HPMS memos, and ability to interpret, communicate, and action CMS guidance specific to the Stars program

Salary Range by Location:

• Oregon: Non-Portland Service Area: Min: $42.08, Max: $65.32
• Oregon: Portland Service Area: Min: $45.14, Max: $70.07
• Washington: Western - Except Tukwila: Min: $47.05, Max: $73.04
• Washington: Southwest - Olympia, Centralia: Min: $45.14, Max: $70.07
• Washington: Clark County: Min: $45.14, Max: $70.07
• Washington: Eastern: Min: $40.16, Max: $62.35
• Washington: Southeastern: Min: $42.08, Max: $65.32

Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.