Manager, Star Quality Improvement

Location: Orange, California US

Notice

This position is no longer open.

Job Number: 3450

Workplace Type: Hybrid Remote

Position Title: Manager, Quality Improvement

External Description:

The Manager, Quality Improvement is responsible for leading quality improvement activities within the Medicare STAR program, including project management, process improvement, campaign coordination, and outcomes measurement. This will encompass all STAR related areas including HEDIS, CAHPS, HOS, and Admin.

General Duties/Responsibilities:

(May include but are not limited to)

·       Possess a deep understanding of the Medicare STAR program and lead the implementation and execution of strategy to improve outcomes.

·       Enhance the relationship with market groups and provider offices by regularly engaging including participation in Joint Work Groups, Joint Operation Committee meetings, and efficiently and effectively responding to requests for information and successfully resolving issues as identified.  

·       Manage a team that consist of Star Coordinators and Analyst Quality Improvement (currently three team members but could increase)

·       Collaborate in planning and execution of quality initiatives, HEDIS/CAHPS/HOS campaigns for the Medicare STAR program. This may include material development, mailing campaigns, IVR calling/SMS (text)/Email campaigns, case review, and other cross-functional initiatives to improve member outcomes.

·       Set targets and priorities to meet national HEDIS/Star and market-specific Medicare Star Program needs.  Research issues related to measures not meeting benchmark and drive internal resolution. 

·       Track and report on outcomes and KPIs for the program to ensure progress is met throughout the various project life cycles for designated market.

·       Utilize available tools, technology, and data to create sophisticated reporting that paints a clear picture and allows for informed analysis and decision-making.

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

Supervisory Responsibilities:

·       Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

Minimum Requirements:

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.

Minimum Experience:

·       Minimum 3 years of HEDIS/STAR of experience and/or 5 years health plan, managed care, or medical group/IPA setting, preferably in quality improvement, HEDIS, or the Medicare STAR program.

·       Minimum 1-2yrs management experience with all aspects of teams

Education/Licensure:

·       Bachelor’s degree (BA or BS) from four-year college or university in a health-related field (Health Science, Health Administration, or related) or equivalent combination of education and experience, required.

Other:

·       Aptitude for critical thinking in complex situations, ability to synthesize ambiguous data into concrete results.

·       Attention to detail, problem solving, and analytical skills are essential.

·       Proficient in Microsoft Office (Outlook, Excel, Work, PowerPoint required. Visio and Access are preferred) and familiar working with large data sets.

·       Knowledge of medical terminology and HIPAA.

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

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

·       Demonstrated leadership ability.

·       Strong communications skills: written, verbal, and interpersonal

Work Environment

·       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.

Preferred Requirements:

may be made to enable individuals with disabilities to perform the essential functions.

Experience in:

·       Data analytics and systems

·       Data reporting, analysis and interpretation

·       Multiple EMR/EHR

·       NCQA/HEDIS Audit

·       SQL, and BI software such as PowerBI or Tableau preferred.

·       Valid Driver’s license

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
 

 

City: Orange

State: California

Location City: Orange

Location State: California

Community / Marketing Title: Manager, Star Quality Improvement

Company Profile:

By leveraging our world-class technology platform, innovative care delivery models, deep physician partnerships and our serving heart culture, Alignment Health is revolutionizing health care for seniors! From member experience professionals and clinicians, to data scientists and operations leaders, we have built a talented and passionate team that is deeply committed to our mission of transforming health care for the seniors we serve. Ready to join us?

At Alignment, delivering exceptional care to seniors starts with ensuring an exceptional experience for our over 1,300 employees. At the center of our employee experience is a culture where employees at all levels and across all teams are encouraged to share their unique ideas and perspectives. After all, when you can bring your authentic self to work, whether that’s in a clinical setting, our corporate office or a home office, creativity and innovation flourish! Another important part of the Alignment culture is a belief in continuous learning and growth. As a result, in this fast-growing company, you will find ample support to grow your skills and your career – with us.

EEO Employer Verbiage:

 

Please note: All clinical positions are contingent upon successful engagement with Alignment Health’s COVID-19 Vaccination program (fully vaccinated with documented proof or approved exception/deferral).

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email [email protected].