Manager, Medicare Stars Program

The Medicare Stars Program Manager is responsible for the successful administration of the Medicare Stars performance program for HMSA’s Medicare Advantage (MA) line of business. Achieving a 4 – 5 Star rating and maximum quality bonus payments from Centers for Medicare and Medicaid Services (CMS) is critical to us maintaining our competitiveness in the MA market, and enable HMSA to deliver a strong clinical quality program as well as the best member experience through administrative excellence.

• Manages Stars team members in order to achieve program goals. Adjusts roles and responsibilities as needs change.
• Champions a blend of formal Quality Management methodology and Agile Management (Agile) as the framework for supporting clinical and/or operational improvement projects.
• Provides subject matter expertise in areas including project scope definition, risk identification, project methodology, resource allocation, facilitation, and other areas of expertise based on established quality and project management techniques.
• Manages priorities, resource constraints, project issues and other factors to ensure that timelines, deliverables and budgets are understood and achieved by staff.
• Develop short-term and long-term strategies to ensure we meet the overall Star rating objective for each MA contract.
  • Works within HMSA, BCBSA and vendors to review programs and processes and develop data collection strategies, reports and outcomes. Reviews data systems related to reporting.
  • Manages the production of the Stars performance dashboard to monitor and report ongoing performance against targets. Adjust the program as needed to ensure goals are met.
  • Supports HMSA as a Subject Matter Expert of Stars and Healthcare Effectiveness Data and Information Set (HEDIS) Technical Specifications, project plans, and reporting logistics
  • Ensures that business processes that provide data and interventions to submit for our Stars program meet CMS and HEDIS compliance.
• Acts as the leader and champion of the Medicare Stars Program. Collaborates with cross-departmental business leaders and external partners to achieve common goals.
• Develops strong business partnerships with key areas throughout the organization and external partners to continually improve performance in our Stars program.
• Provides education and information to the entire HMSA community regarding Stars. Communicates program results to all levels of staff including executive management as needed.
• Continuously reviews and implements opportunities to further align Stars activities with risk adjustment initiatives to optimize care improvement opportunities with revenue management.
• Manages Stars Program Office staff in assignment of projects and work, performance management, career development, compensation, recruitment, training and development. Prepare and monitor documentation and budget for area of responsibility. Review budget versus actual expenditures.
  • Supports leadership in the development, implementation and reporting for HMSA’s Chronic Care Improvement Programs and Quality Improvement Projects as required by CMS.
• Other Duties/Functions:
  • Performs all other miscellaneous responsibilities and duties as assigned or directed.

• Bachelor’s degree and five years of related work experience; or equivalent combination of education and related work experience.
• Two years of previous supervisory or management experience.
• Possess a strong working knowledge of HEDIS, Consumer Assessment of Healthcare Providers and Systems (CAHPS) and Health Outcomes Survey (HOS) processes and NCQA performance standards.
• Experience leading diverse teams in matrix organizations.
• Skill in drive change and innovative thinking in continuous quality improvement.
• Basic knowledge of Microsoft Office applications. Including but not limited to Word, Excel, Outlook, and Power Point