Program Manager

Overview

The program manager is responsible for developing, administering and managing the quality programs in support of the commitment to providing high quality care and service. The program manager will have responsibility for the Medicare Advantage Part D Stars, quality, and risk adjustment programs; the annual HEDIS, CAHPS, and HOS processes; and support of compliance, accreditation (NCQA, URAC) and recognition standards. The program manager will also work with the provider network team to help develop and educate providers on strategies to improve quality.

Responsibilities

Leads, develops and manages details work plans, establishes deadlines, assigns responsibilities, monitors overall project progress, and reports progress regularly to internal stakeholders for the Medicare Star program, Healthcare Effectiveness Data and Information Set (HEDIS), Health Outcomes Survey (HOS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) vendor.--------------------------------------------------Leads, develops and manages the Risk Adjustment Program to achieve improvements for Risk Adjustment Payment System (RAPS), as well as the Encounter Data Processing system (EDPS). This position will manage the technical and business operations of Medicare payment systems and also be responsible for maintaining an effective working and oversight relationship with downstream vendor(s) engaged in these processes--------------------------------------------------Defines, develops, organizes and communicates program interventions and analytical plans to support quality improvement initiatives, Quality Improvement Programs (QIP), Chronic Care Improvement Projects (CCIP). Collects, analyzes, summarizes information and trends, consults on research projects, and recommends actions to improve quality measures in support of Star rating goals. --------------------------------------------------Manages the contractual relationship with NCQA-certified HEDIS vendor, HEDIS auditor, Health Outcomes Survey (HOS) vendor, and Consumer Assessment of Healthcare Providers and Systems (CAHPS) vendor. Ensures all aspects of the annual submission process are effectively coordinated and that submissions are successful. --------------------------------------------------

Qualifications

EDUCATION:Required: Bachelor?s Degree in business or health related field Preferred: Master?s Degree in business, health related field, or clinical degree (RN, NP, PA, PharmD, etc.) EXPERIENCE:Required:? 5+ years? experience in health care with at least 2 of those years functioning in management/leadership roles within health care; including managing cross-functional teams and influencing without direct authority.? 2 years demonstrated experience performing quality improvement initiatives related to the Medicare Stars Program ? Experience working with vendors? Proficient in Word, Excel and PowerPointPreferred:? Experience working with regulatory agencies (CMS) ? Experience leading/ coordinating initiatives to improve ratings for quality programs? Experience performing clinical data analysis to identify trends and establish quality improvement goals and benchmarks LICENSURE/CERTIFICATION/REGISTRY/LISTING:REQUIREDValid Driver's License | Valid Driver's LicensePREFERRED