Stars Manager - Member Experience (Hybrid)

CareFirst BlueCross BlueShield; Baltimore (MD); On-site; USD 108,000 - 200,000; Full time

Job summary

CareFirst BlueCross BlueShield seeks a Manager, Stars (Member Experience) to lead a team responsible for designing, launching, and executing programs that enhance member experience and retention to achieve 4 Star Ratings in Medicare Advantage plans. The role emphasizes cross-functional leadership, data-driven strategy, and collaboration with CMS and other partners.

The position requires a Bachelor's degree or equivalent experience with 5+ years in a healthcare payer environment, including

Qualifications

• Education: Bachelor's Degree minimum; 4 additional years of related work experience if no Bachelor's.
• Experience: 5+ years in a healthcare payer setting; 1 year supervisory experience in Government Programs.

Responsibilities

• Lead and develop a team driving member experience improvements across a matrixed organization.
• Develop and oversee strategy for enterprise CAHPS initiatives and related programs.
• Analyze CAHPS, Pulse survey, complaints and call data to shape strategy and actions.
• Own cross-functional relationships; engage with CMS, BCBSA, and partners on Stars improvements.
• Oversee STARS-related surveys for all lines of business and regulatory programs.

Skills

CMS Stars knowledge

Medicare Advantage experience

Stakeholder presentations

Matrixed environment collaboration

Education

Bachelor's Degree OR equivalent experience

Job description

Resp & Qualifications

The Manager, Stars (Member Experience) leads a team and is responsible for the design, launch, and execution of cross-functional programs that support member experience and retention initiatives to improve the quality of care and member experience, resulting in 4 Star Ratings for Medicare Advantage plans.

Purpose

The Manager, Stars (Member Experience) leads a team and is responsible for the design, launch, and execution of cross-functional programs that support member experience and retention initiatives to improve the quality of care and member experience, resulting in 4 Star Ratings for Medicare Advantage plans.

Essential Functions

• Manages, develops, and leads a team responsible for driving member experience improvement in a matrixed organization environment.
• Develops and oversees strategy and execution of enterprise CAHPS strategy and initiatives.
• Analyzes key data points (such CAHPS survey results, Pulse survey results, complaints, grievances, call center data) to develop strategy
• Owns cross-functional relationships and works with key partners to drive member experience improvement that crosses multiple functional areas.
• Develop provider engagement strategy for CAHPS improvement.
• Oversee member experience surveys for all LOBs, including regulatory and non-regulatory surveys.
• Conduct impact analysis and formulate actions related to regulatory changes and implement appropriate changes and process improvements to drive CareFirst plans towards 4 Star outcomes. Collaborate across the eco-system such as CMS, BCBSA, etc. to support necessary regulatory improvements to enable optimal Star ratings. Serve as an Member Experience/CAHPS/Stars SME to guide the key stakeholders in bid filings and plan performance strategies and actions.
• Manage direct reports and vendors to execute goals related to STARS performance. Coach and guide associates to achieve departmental goals. Recruit, retain, and develop a high-performing team. Evaluate the performance of each team member, generate development plans and set goals within the context of the corporate policies and procedures. Develop annual goals and assist with departmental budget to control and appropriately allocate resources.
• Scale Medicare Advantage solutions for member experience across all lines of business.

Supervisory Responsibility

This position manages people.

Qualifications

Education Level: Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 5 years of progressive responsibility in a healthcare payor environment. 1 year of supervisory or demonstrated progressive leadership experience within Government Programs.

Preferred Qualifications

• Master's in business administration, Master's in health administration, or Master's in public/Population health.

Knowledge, Skills And Abilities (KSAs)

• Expert knowledge of all regulatory guidelines on CMS Star Rating methodologies.
• Experience in member experience, healthcare operations, Medicare Advantage.
• Experience driving a Medicare Advantage plan to 4 Stars.
• Skilled in successfully planning and leading presentations to internal and external stakeholders, and C-suite with a focus on CMS Stars.
• Ability to work in a fast-paced environment and drive consistent actions across a matrixed environment.

Salary Range:

$108,000 - $200,475

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

Physical Demands

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship