Quality Improvement Lead

Overview of the Role: 

Oversee, organize, and monitor Medicare Star Program projects while cultivating strong relationships with internal and external partners. Ensure the development and execution of integrated processes and systems that align with the goals of the Star program and support organizational goals.

The Medicare Provider Relations Star Specialist will report to the Director of Quality Improvement and is responsible for coordinating projects with network management, facilitate information exchange between the Star team and provider network, support improvement activities within the Medicare Star program, including project management, process improvement, and campaign coordination. This position will encompass all Star related areas including HEDIS, CAHPS, HOS, and administrative measures.

Responsibilities:

1.     Demonstrate a thorough understanding of the Medicare Star program while spearheading strategies to enhance outcomes, frequently engaging in public speaking and collaborating closely with both internal and external partners.

2.     Develop and facilitate trainings for both internal and external employees on any updates to the Star program.

3.     Adapt to and thrive in an actively changing environment, demonstrating flexibility in response to new rule makings by CMS on a year-over-year basis.

4.     Enhance the relationship with external group and provider partners by preparing for, engaging, and leading Joint Work Groups, Joint Operation Committee meetings.

5.     Efficiently and effectively respond to requests for information and successfully resolving issues as identified across multiple group partners.

6.     Track and report on outcomes and KPI’s for the program to ensure progress is met throughout the various project life cycles for designated market.

7.     Develop and track project work plans by defining tasks, setting deadlines, and assigning responsibilities.

8.     Monitor and control work by measuring progress and correcting course when activities go beyond scope or are not meeting goals and objectives.

9.     Collaborate in strategy, planning and execution of quality initiatives and HEDIS campaigns for the Medicare Star program – this may include material development, mailing campaigns, PowerPoint creation, IVR calling campaigns, case review, and other cross-functional initiatives to improve member outcomes.

10.  Maintain positive relationships within Alignment Healthcare business units and operational departments and other project stakeholders by coordinating information exchange, keeping stakeholders informed of progress and risks, and maintaining project documentation.

11.  Exercise creativity and flexibility by determining the appropriate combination of knowledge, skills, tools, and techniques for assigned projects.

12.  Ensure patient privacy is protected by adhering to HIPAA standards, company policies and procedures, and other federal, state, and local requirements.

Required Skills and Experience:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Pay Range- $68,000-$75,000 Annually 

1.     Minimum Experience:

a.     Minimum 3 years of experience in a health plan, managed care, or medical group/IPA setting, preferably in quality improvement, HEDIS, or the Medicare Star program.

2.     Education/Licensure:

a.     Bachelor’s degree (BA or BS) from four-year college or university in a health-related field (Health Science, Health Administration, or related) required.

b.     Valid Driver’s License

3.     Other:

a.     Knowledge of medical terminology and HIPAA.

b.     Mathematical skills, attention to detail, problem solving, and analytical skills are essential.

c.      Self-starter; able to work independently with minimal supervision.

d.     Demonstrated leadership and public speaking ability

e.     Strong communications skills: written, verbal, and interpersonal

4. Work Environment:

f.      The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact [email protected].