Medicare STARS Program Manager

The pay range above represents the minimum and maximum rate for this position in California. Factors that may be used to determine where newly hired employees will be placed in the pay range include the employee specific skills and qualifications, relevant years of experience and comparison to other employees already in this role. Most often, a newly hired employee will be placed below the midpoint of the range. Salary range will vary for remote positions outside of California and future increases will be based on the pay band for the city and state you reside in.

Work Culture:

GCHP strives to create an inclusive, highly collaborative work culture where our people are empowered to grow and thrive.  This philosophy enables us to create the health plan of the future and do our best work – Together.

GCHP promotes a flexible work environment. Employees may work from a home location or in the GCHP office for all or part of their regular workweek (see disclaimer).

GCHP’s focuses on 5 Core Values in the workplace:

•    Integrity

•    Accountability

•    Collaboration

•    Trust 

•    Respect

Disclaimers:

•    Flexible work schedule is based on job duties, department, organization, or business need.

•    Gold Coast Health Plan will not sponsor applicants for work visas.

POSITION SUMMARY

The Medicare STARS Program Manager is responsible for informing, promoting, and leading the evolution of Gold Coast Health Plan’s (GCHP) managed care systems to maximize quality as measured by the Centers for Medicare and Medicaid Services (CMS) 5 STAR Rating System.

Reporting to the Senior Director of Quality Improvement, the Medicare STARS Program Manager plays a pivotal role to strategically optimize operational initiatives plan wide to maximize GCHP’s Duals Special Needs Plan (D-SNP) STAR ratings, and to elevate GCHP’s Medicare STAR Rating Program governance.

The successful candidate is a subject matter expert (SME) in regulations that govern the CMS Medicare D-SNP STAR Rating System, and in the application of operational strategies and tactics to maximize Star Rating System outcomes. The Senior Quality Improvement Program Manager will serve as a high-level individual contributor.

Amount of Travel Required: 5-10%

Reasonable Accommodations Statement

To accomplish this job successfully, an individual must be able to perform, with or without reasonable accommodation, each essential function satisfactorily. Reasonable accommodations may be made to help enable qualified individuals with disabilities to perform the essential functions.

ESSENTIAL FUNCTIONS

Job Function & Responsibilities

•    Sustained up-to-date D-SNP STARS System subject matter expertise of significant complexity, understanding of the present and future operational impacts of changes to STAR Rating Program requirements.

•    Ability to clearly communicate STAR Rating System requirements and their impacts to operational systems enterprise-wide; collaboration with cross-functional teams to build an understanding of the intersection between STAR Rating requirements and the operational excellence required to achieve exceptional member experience and outcomes.

•    Subject Matter Expertise liaison to stakeholders’ enterprise-wide to provide strategic guidance to support and promote process deployment, refinement, and execution to maximize STAR ratings.

Collaborate with cross-functional teams to drive systems improvement to maximize STAR measure ratings, with duties including but not limited to:

•    At least annually develop Gold Coast Health Plan’s (GCHP) STAR Rating Program strategic objectives as a component of the Quality Improvement and Health Equity Transformation Program (QIHETP) Work Plan, and in congruence with the Population Health Management Strategy, and Operating Plan. Update STAR Rating Program strategic objectives quarterly in congruence with emerging requirements and priorities.

•    Own relationship with and optimize use of vendor STARS applications, and design and implement solutions in collaboration with cross-functional stakeholders and the Information Technology Division, to monitor performance relative the STAR Rating Program goals and enable effective STAR Rating Program governance.

•    Cultivate and sustain mutually beneficial partnerships with vendors that provide systems to monitor and manage STARS performance.

•    Monitor, track, and communicate STARS-related Key Performance Indicator (KPI) outcomes, to demonstrate and elevate the effectiveness of the plan’s STAR Rating Program.

•    Oversee the preparati