Manager, STARS Member Experience

🕒 4 dias atrás

🌪️ Oklahoma – Remoto

🌪️ Oklahoma – Remote

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

👻 Score fantasma 12%

O que significa: quão provável esta vaga está aberta sem contratação ativa.Como ler: 60% ou mais significa que achamos que é uma vaga fantasma. Pontuações mais baixas preocupam menos.Como pontuamos: tempo em aberto, republicações, vagas abertas vs tamanho do time, rapidez para fechar vagas, e se o salário está divulgado.Observação: é uma estimativa de dados públicos, não um julgamento da empresa. Vagas reais podem ter pontuação alta, então use como uma dica, não como um fato.

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GlobalHealth, Inc.

SiteLinkedInTodas as Vagas

51 - 200 funcionários

Fundada em 2003

🛡️ Seguros

🏥 Saúde

⚕️ Seguro de Saúde

Insurance • Healthcare • Healthcare Insurance

A GlobalHealth, Inc. é uma empresa de seguro saúde que oferece planos Medicare Advantage (Parte C) HMO, incluindo Planos de Necessidades Especiais Crônicas (C-SNP) e Planos de Necessidades Especiais Duais (D-SNP), atendendo principalmente beneficiários em Oklahoma. A empresa fornece planos contratados pelo Medicare e Medicaid com cobertura para medicamentos prescritos (Parte D), benefícios suplementares (dentário, visão, audição, subsídios OTC), serviços de suporte domiciliar, transporte, benefícios fitness, além de portais e ferramentas para membros e provedores para inscrição, reivindicações e gerenciamento de cuidados. A GlobalHealth foca em atender aposentados e populações com dupla elegibilidade ou com doenças crônicas através do suporte de agentes locais, redes de provedores e conformidade com os padrões de qualidade do Medicare.

Descrição

• Provide guidance and training to the Quality department and organization-wide staff involved in member experience improvement initiatives • Manage member experience survey ratings, including member and provider outreach • Develop, plan, and implement quality member experience improvement initiatives and recommend changes • Direct member experience processes to support NCQA accreditation and a 4+ STAR rating • Ensure monthly fielding of pre-CAHPS member surveys and communicate results to external provider groups • Build and maintain relationships with internal departments and external provider groups regarding STARS and NCQA • Implement survey improvement initiatives, including CAHPS committee meetings, to increase member survey scores • Create wellness materials for marketing distribution to support member retention and health improvement • Maintain expert technical understanding of HEDIS, CAHPS, HOS, NCQA, Meaningful Use, and CMS performance standards • Manage and monitor the CAHPS/HOS survey vendor • Develop and implement the Medicare AWV/HRA program to increase provider and member participation • Set actionable goals for Quality Department implementation toward earning and maintaining a 4 STAR rating • Create organization-wide training materials on member experience surveys • Maintain confidentiality of business information and PHI • Serve as a coach and mentor for positions contributing to member experience ratings • Perform other duties as assigned

🎯 Requisitos

• Bachelor's degree or equivalent experience required • 5 years of experience in a clinical or health insurance setting required • 5 years of experience managing data to create reports required • Experience in medical quality, marketing, risk adjustment, coding, and/or wellness preferred • Valid state driver's license required • Ability to communicate and manage complex working relationships • Ability to train internal and external parties • Strong organizational, verbal, written, time management, and telephone skills • Computer literacy and familiarity with Microsoft Word, Excel, and Outlook • Basic electronic health record knowledge and ability to quickly learn new software • Detailed knowledge of quality performance measures and clinical health care • Ability to collaborate across departments • Ability to maintain confidentiality of business information and Protected Health Information (PHI) as required by HIPAA and company policy • Ability to travel to present Quality survey updates to in-network provider groups and attend educational conferences • Ability to lift up to 25 lbs as necessary

🏖️ Benefícios

• Affordable health insurance coverage • Personalized, engaging, and responsive member services • Training and professional development through educational conferences and measure updates • Remote work arrangement • Day shift