Manager, Medicare STARS

Job not on LinkedIn

🔥 15 minutes ago

🇺🇸 United States – Remote

💵 $94.1k - $164.8k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Build enterprise-wide processes and strategy to improve Medicare Quality Measures, including state-specific requirements/measures • Lead strategic initiatives for Stars, MMP withhold and penalty recapture, and other quality rating programs • Support Pharmacy quality, HEDIS Chart Chase, provider engagement, quality strategy builds, and quality improvement initiatives • Oversee Quality Improvement and Quality Management activities for regulatory and quality measure requirements across markets • Coordinate CMS and regulatory reporting with senior leadership monthly, quarterly, and yearly • Generate monthly reporting, dashboards, and recommendations based on measure performance monitoring • Lead HEDIS Medicare chart chase metric tracking and participate in HEDIS roadmap creation and implementation • Conduct monthly and quarterly quality reviews with enterprise, market quality, pharmacy, and care management stakeholders • Support meetings with provider groups and pharmacies using quality scorecards and improvement strategies • Collaborate cross-functionally to identify process gaps and drive improvements • Analyze and report financial savings from performance and process improvements • Compile reports and communications identifying state requirement differences and scaling opportunities • Establish best practices for programs and interventions that improve quality of care, member experience, Stars ratings, and care gaps • Build working relationships across IT, Provider Relations, Service Operations, Case Management, Pharmacy, Medicare Product, and Quality Improvement teams • Coordinate team activities, member outcomes, staff orientation, training, productivity, development, quality improvement, and compliance • Support plan performance on Performance/Quality Improvement Plans under state regulators and CMS • Lead enterprise and market QI work plans, QIPs, PIPs, and CCIP • Maintain Trilogy documents and assigned Models of Care sections • Perform other requested job duties

🎯 Requirements

• Bachelor’s Degree in healthcare field, business administration or related field, or equivalent years of relevant work experience is required • Minimum of five (5) years of Managed care experience is required • Minimum of three (3) years in quality improvement experience in HEDIS and/or Pharmacy Quality measures required • Intermediate proficiency level of Microsoft Outlook, Word and Excel • Ability to operate smart phone, iPad, or other mobile communication devices • Ability to communicate effectively with a diverse group of individuals • Ability to multi-task and work independently within a team environment • Ability to collaborate with and effectively lead other team members • Knowledge of state and federal healthcare environment • Critical listening and thinking skills • Decision making and problem-solving skills • Proper grammar usage • Strong organizational and time management skills • Proper phone etiquette • Customer service oriented • Training/teaching skills • Leadership and/or Project/Program Management skills

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Flexible hours, including possible evenings and/or weekends as needed

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