Manager, Star Quality Improvement

Location: Orange, California US

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Job Number: 3450

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:

Alignment Healthcare was founded with a mission to revolutionize health care with a serving heart culture. Through its unique integrated care delivery models, deep physician partnerships and use of proprietary technologies, Alignment is committed to transforming health care one person at a time.

By becoming a part of the Alignment Healthcare team, you will provide members with the quality of care they truly need and deserve. We believe that great work comes from people who are inspired to be their best. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment community.

EEO Employer Verbiage:

Alignment has implemented a policy requiring all new hires to receive the COVID-19 vaccine and booster.  Proof of vaccination and booster will be required as a condition of employment subject to applicable laws concerning exemptions/accommodations.  This policy is part of Alignment’s ongoing efforts to ensure the safety and well-being of its staff and community, and to support public health efforts.

Alignment Healthcare, LLC is proud to practice Equal Employment Opportunity and Affirmative Action. We are looking for diversity in qualified candidates for employment: Minority/Female/Disable/Protected Veteran.

If you require any reasonable accommodation under the Americans with Disabilities Act (ADA) in completing the online application, interviewing, completing any pre-employment testing or otherwise participating in the employee selection process, please contact careers@ahcusa.com.