Become a part of our caring community and help us put health first
 

Health Quality and Stars (HQS) is an organization that is responsible for improving health outcomes and advancing the care experience of our members and provider partners through quality solutions. HQS is committed to caring for our customers and delivering high plan quality as rated by the Centers for Medicare and Medicaid Services (CMS).

The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures covering preventive care screenings, health condition management, health outcomes, patient experience, and plan operations.

The CMS Stars quality rating system evaluates Medicare Advantage and Prescription Drug Plans using approximately 40 measures covering preventive care screenings, health condition management, health outcomes, patient experience, and plan operations.

The Director, Stars CAHPS Improvement and Operations is responsible for overseeing the implementation, management, and continuous improvement of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) initiatives as part of the CMS Stars Program. This role will focus on enhancing member experience and satisfaction, ensuring compliance with regulatory requirements, and driving strategies to improve CAHPS scores.

Key Responsibilities:

• Serve as an internal expert on CAHPS survey methodology, regulatory changes, and CMS guidance

• Monitor CAHPS results, identify trends and areas of opportunity, and drive continuous improvement

• Accelerate shared accountability for CAHPS improvement by effectively communicating the strategy to the Enterprise to create alignment, inspire action and deliver tangible results

• Develop and maintain a portfolio of improvement initiatives focused on delivering improved member experience and satisfaction, targeting key drivers of CAHPS performance

• Collaborate with cross-functional teams (clinical, customer service, member engagement, analytics) to design, test, and scale interventions that directly impact Star ratings

• Responsible for initiative performance monitoring and development of deep, holistic operational reporting, with regular executive summary roll-up to Stars leadership

• Lead multiple analytics partners to develop robust reporting informing prioritized opportunities for Quality improvement and experience; requires ability to derive insights from large quantities of data

• Develop strategic recommendations for program evolution and policy advocacy, including written summaries and talking points for engagement with CMS, industry groups, and internal stakeholders

• Oversee budget, vendor relationships and project/ program management

• Lead and develop team of high- performing direct reports

Use your skills to make an impact
 

Required Qualifications

• Bachelor’s Degree

• 8+ years of experience in Medicare Advantage quality, Stars and/or member experience

• 3 years or more of management experience

• Strong operational and project management skills, with a track record of performance improvement

• Experience driving enterprise strategy

• Exceptional communication, collaboration, and influence skills

• Analytical mindset with ability to interpret data and generate strategic insights

Desired Qualifications

• Masters degree

• Deep understanding of CAHPS survey methodology, Stars weighting, and CMS expectations

Additional Information

As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lac