Quality Improvement - Manager STARS at CommunityCare

Tulsa, Oklahoma, United States -

Full Time

Start Date

Immediate

Expiry Date

25 Jul, 26

Salary

0.0

Posted On

26 Apr, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

CMS Star Ratings, Project Management, Data Analytics, Managed Care, HEDIS, Strategic Planning, Process Improvement, Regulatory Compliance, Leadership, Cross-functional Collaboration, KPI Tracking, Stakeholder Management, Healthcare Administration, Data Interpretation, Microsoft Office

Industry

Insurance

Description

Job Summary: The Stars Manager is responsible for leading the design, implementation, and continuous improvement of strategies to achieve and maintain superior CMS Star Ratings. This role serves as the key driver of cross-functional initiatives, leveraging data analytics, regulatory expertise, and strong leadership to optimize quality performance and member outcomes. The Stars Manager will develop, communicate, and execute strategy and goals within a matrixed organizational environment, ensuring alignment with corporate objectives and regulatory requirements. Overall percentage of responsibilities pertaining to quality activities for this job role is 100%. KEY RESPONSIBILITIES: Serve as a subject matter expert on CMS Star Ratings, providing ongoing education and guidance to teams across the organization to build a shared commitment to excellence and regulatory compliance. Continuously monitor, evaluate, and report on the effectiveness of Stars initiatives, proactively identifying opportunities for improvement and implementing best-in-class solutions to achieve and sustain top-tier Star Ratings. Ensure that best practices are followed and develop innovative approaches in collaboration with internal and external stakeholders to improve member and provider engagement, driving initiatives that directly impact Star Ratings outcomes and foster a culture of excellence. Analyze and interpret data from multiple data sources to identify trends, evaluate efficacy, proactively solve complex problems, remediate risks, and develop plans to drive continuous improvement across all Stars measures. Lead the strategy and tactical direction to improve member experience and provider HEDIS engagement, ensuring alignment with corporate objectives and CMS Star Ratings criteria, and champion efforts to achieve and maintain 4+ Star performance levels. Work closely with data analysts to develop and manage targeting and monitoring capabilities, establishing robust tracking systems and KPIs to ensure progress toward Star Ratings targets is transparent and actionable. Develop content for leadership review, structure decks, anticipate key issues and questions and data needed to drive productive discussion, and provide strategic recommendations to support executive decision-making and Star Ratings advancement. Stay abreast of and keep the organization appraised of existing and new issues impacting Star ratings; lead program updates as needed and incorporate into work programs and processes, ensuring timely adaptation to CMS changes and industry best practices. May engage and oversee the work of external vendors, holding partners accountable for delivering high-quality results that contribute to the organization's Star Ratings objectives. Proactively manage workload to consistently meet tight deadlines while maintaining prompt and effective communication in response to project needs. QUALIFICATIONS: Excellent written, verbal, and presentation skills. Excellent analytical skills. Interpersonal skills to create relationships, and advance STARS objectives. Proficient in Microsoft Office applications. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: Bachelor’s Degree in Nursing, Business, Finance, healthcare or related field. Master’s Degree preferred in a healthcare field (MPH, MSN, MHA) Three or more years of Medicare Stars Program and project management experience. Managed Care experience. Five or more years’ experience in managing teams, both direct reports and in a matrixed environment Project management and process improvement experience preferred. CommunityCare is an equal opportunity at will employer and does not discriminate against any employee or applicant for employment because of age, race, religion, color, disability, sex, sexual orientation or national origin

Responsibilities

The Stars Manager leads the design and implementation of strategies to achieve and maintain superior CMS Star Ratings through cross-functional initiatives. They are responsible for analyzing data, monitoring performance, and collaborating with stakeholders to improve member and provider engagement.