STARS & NCQA Member Experience Manager

GlobalHealth, Inc.; Oklahoma City (OK); On-site; USD 65,000 - 90,000; Full time

Job summary

GlobalHealth, Inc. seeks a quality-focused professional to guide member experience initiatives and ensure NCQA accreditation with a 4+ STAR rating. You will oversee CAHPS surveys, coordinate with provider groups, and develop wellness materials to improve member engagement and health outcomes.

Responsibilities include directing member experience processes, managing CAHPS/HOS vendor performance, and developing Medicare AWV/HRA programs while maintaining PHI confidentiality.

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 Drivers License.

Responsibilities

• Develops, plans, and implements quality member experience initiatives.
• Directs member experience processes to meet NCQA accreditation and 4+ STAR rating.
• Ensures pre-CAHPS surveys are fielded monthly and shares results with external provider groups.
• Builds and maintains relationships with internal departments and external provider groups.
• Implements survey improvement initiatives including CAHPS committee meetings.
• Creates wellness materials for marketing to aid member retention and health improvement.
• Maintains knowledge of HEDIS, CAHPS, HOS, NCQA and CMS measures.
• Manages and monitors performance for CAHPS/HOS survey vendor.
• Develops Medicare AWV/HRA program to increase participation.
• Sets goals for Quality Department toward earning a 4 STAR.
• Creates training material on member experience surveys for staff.
• Maintains confidentiality of PHI per HIPAA and policy.
• Performs other duties as assigned.

Skills

Quality management

Data reporting

CAHPS & NCQA knowledge

HIPAA compliance

Education

Bachelor's degree or equivalent experience

Job description

GlobalHealth, Inc. seeks a quality-focused professional to guide member experience initiatives and ensure NCQA accreditation with a 4+ STAR rating. You will oversee CAHPS surveys, coordinate with provider groups, and develop wellness materials to improve member engagement and health outcomes.

Responsibilities include directing member experience processes, managing CAHPS/HOS vendor performance, and developing Medicare AWV/HRA programs while maintaining PHI confidentiality.