Quality Stars Program Coordinator

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

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Quality Stars Program Coordinator

Full Time Professional Wheeling, WV, US 1 Attachments

Under the leadership and direction of the Vice President Quality Improvement, the Quality Stars Program Coordinator will focus on the clinical operations for Medicare Star initiatives and other quality improvement initiatives that interface with Clinical Services, Pharmacy, Quality Improvement and the Medical Economics Departments. This position is responsible for data analysis and reporting to identify trends, gaps in care, and opportunities for improvement. Conducts outreach to members and providers to improve adherence to measures. Reviews and analyzing member and provider complaints along with survey results to improve outcomes. Interfaces with the Provider Operations and Provider Experience teams for quality provider initiatives and provider education. See job description attached.

Required:

• Bachelor's degree or equivalent healthcare industry experience (five years).
• Minimum of two years of experience related to any of the following: Managed Care, Medicare Stars, HEDIS, CAHPS, HOS.
• Has the ability to prioritize and pivot to achieve goals with minimal supervision.
• Ability to build working relationships with internal staff and external stakeholders including community and vendor partners.
• Medicare Star Ratings experience with the ability to analyze and interpret cut point predictions.

Responsibilities:

• Works with VP, Quality Improvement and Clinical Quality Stars Program Manager to learn and apply the Medicare Part C&D Star Ratings Technical Notes.
• Communicates with the Medical Economics Department and the Clinical Quality Stars Program Manager to obtain ongoing HEDIS and Stars data collections to support SMART goals.
• Works with internal departments to identify opportunites for improvement, gap closure and facilitates the development of member and provider clinical data driven initiatives to promote optimal member outcomes and provider best practices.
• Assists with tracking systems for reporting KPIs for the evaluation of activities and the effectiveness related to program initiatives and other performance/quality improvement projects.
• Interfaces with the Provider Operations and Provider Experience teams for quality provider initaitives and provider education.
• Using the PDSA cycle, identifies barriers and opportunities for improvement related to Star ratings, NCQA, CAHPS and HOS surveys and other member experience or quality metrics.
• Assists to development training and educational material that directly impacts quality initiatives.
• Participates in quality improvement meetings and committees/subcommittees and focus groups.

Equal Opportunity Employer

The Health Plan is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. The Health Plan strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. The Health Plan employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.