Manager, STARS Member Experience

🔥 0 minutes ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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GlobalHealth, Inc.

WebsiteLinkedInAll Job Openings

51 - 200 employees

Founded 2003

🛡️ Insurance

🏥 Healthcare

⚕️ Healthcare Insurance

Insurance • Healthcare • Healthcare Insurance

GlobalHealth, Inc. is a health insurance company that offers Medicare Advantage (Part C) HMO plans, including Chronic Special Needs Plans (C-SNP) and Dual Special Needs Plans (D-SNP), primarily serving beneficiaries in Oklahoma. It provides Medicare and Medicaid-contracted benefit plans with prescription drug (Part D) coverage, supplemental benefits (dental, vision, hearing, OTC allowances), home support services, transportation, fitness benefits, and member/provider portals and tools for enrollment, claims, and care management. GlobalHealth focuses on serving retirees and dual-eligible or chronically ill populations through local agent support, provider networks, and compliance with Medicare quality standards.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• 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