Medicare STARS Program Manager

Salary Range: $114,138 - $171,207

Job Summary

The Quality Department is committed to preventing disease, ensuring patient safety, and eliminating inequities by improving the quality of care received by members through partnerships with providers and community-based organizations.

The Medicare STARS Program Manager is responsible for informing, promoting, and leading the evolution of CenCal Health’s managed care systems to maximize quality as measured by the Centers for Medicare and Medicaid Services (CMS) 5 STAR Rating System.

Reporting to the Executive Quality and Population Health Officer, the Medicare STARS Program Manager plays a pivotal role to strategically optimize operational initiatives plan wide to maximize CenCal Health’s Duals Special Needs Plan (D-SNP) STAR ratings, and to elevate CenCal Health’s Medicare STAR Rating Program governance.

The successful D-SNP STAR Program Manager is a subject matter expert (SME) in regulations that govern the CMS Medicare D-SNP STAR Rating System, and in the application of operational strategies and tactics to maximize Star Rating System outcomes. The Medicare STARS Program Manager will serve as a high-level individual contributor.

Duties and Responsibilities:

Key responsibilities include:

1. Sustained up-to-date D-SNP STARS System subject matter expertise of significant complexity, understanding of the present and future operational impacts of changes to STAR Rating Program requirements.
2. Ability to clearly communicate STAR Rating System requirements and their impacts to operational systems enterprise-wide; collaboration with cross-functional teams to build an understanding of the intersection between STAR Rating requirements and the operational excellence required to achieve exceptional member experience and outcomes.
3. Subject Matter Expertise liaison to stakeholders’ enterprise-wide to provide strategic guidance to support and promote process deployment, refinement, and execution to maximize STAR ratings.

Collaborate with cross-functional teams to drive systems improvement to maximize STAR measure ratings, with duties including but not limited to:

• At least annually develop CenCal Health’s STAR Rating Program strategic objectives as a component of CenCal Health’s Quality Improvement and Health Equity Transformation Program (QIHETP) Work Plan, and in congruence with CenCal Health’s Population Health Management Strategy, and Operating Plan. Update  STAR Rating Program strategic objectives quarterly in congruence with emerging requirements and priorities.
• Optimize use of vendor STARS applications, and design and implement solutions in collaboration with cross-functional stakeholders and the Information Technology Division, to monitor performance relative to CenCal Health’s STAR Rating Program goals and enable effective STAR Rating Program governance.
• Cultivate and sustain mutually beneficial partnerships with CenCal Health’s vendors that provide systems to monitor and manage STARS performance.
• Monitor, track, and communicate STARS-related Key Performance Indicator outcomes, to demonstrate and elevate the effectiveness of CenCal Health’s STAR Rating Program.
• Oversee the preparation and filing of the measures included in the CMS STAR Rating Program and maintain reports and back up information to review preliminary measure results to ensure the accuracy of the STAR Rating Program information.

Serve as a SME and resource enterprise-wide, providing strategic guidance to CenCal Health Senior Leadership Team and stakeholders, with duties including but not limited to:

• Collaborating with CenCal Health’s teams, including but not limited to Population Health Management, Medical Management, Member Services, and Quality, to promote the evolution of operational systems aligned with STAR Rating Program goals and CMS requirements.
• Stay informed and up to date about prospective changes to D-SNP STARS Program measures, reporting requirements and program updates, and communicate requirements to relevant stakeholders to maximize the time to adapt operational systems to changes in D-SNP STARS requirements.
• Support the development of robust Auditing & Monitoring (A&M) activities to assure complete and accurate data sources and processes necessary to generate reliable source data that complies with CMS D-SNP STARS measure specifications.
• Promote alignment of organizational processes and strategies with D-SNP STAR Rating Program requirements, and the execution of strategies and tactics to maximize CenCal Health’s STAR ratings.
• Assure readiness for CMS D-SNP STARS audits, and coordinate, facilitate and ensure timely response to audit findings, including timely development, implementation, and closure of corrective action plans (excludes annual NCQA HEDIS Compliance Audit).
• Contribute expertise and STARS Program performance insights to multidisciplinary teams to collaboratively plan, deploy, and execute strategies and processes to continuously monitor, achieve, and sustain 5-star ratings.
• Develop and facilitate training to CenCal Health staff to maximize CenCal Health D-SNP STARS Program readiness.
• Attend stakeholder meetings as requested.
• Other duties as assigned.

Motivate others to create extraordinary results, and unite people to turn challenges into successes by embracing ‘The Five Practices of Exemplary Leadership’ of The Leadership Challenge:

1. Model the Way:

• Clarify values by finding your voice and affirming shared values
• Set the example by aligning actions with shared values

2. Inspire a Shared Vision

• Envision the future by imagining exciting and ennobling possibilities
• Enlist others in a common vision by appealing to shared aspirations

3. Challenge the Process

• Search for opportunities by seizing the initiative and my looking outward for innovative ways to improve
• Experiment and take risks by consistently generating small wins and learning from experience

4. Enable Others to Act

• Foster collaboration by building trust and facilitating relationships
• Strengthen others by increasing self-determination and developing competence

5. Encourage the Heart

• Recognize contributions by showing appreciation for individual excellence Celebrate the values and victories by creating a spirit of community.

Knowledge/Skills/Abilities

Required:

• Extensive knowledge of prevailing CMS D-SNP STAR Rating Program requirements, measures and calculations, industry best practices, and ability to collaboratively serve as a SME and technical resource enterprise-wide.
• Ability to function effectively as CenCal Health’s liaison to CMS when a STAR Rating Program SME is appropriate to fulfill CMS and/or CenCal Health expectations.
• Analytical mindset with the ability to interpret data, identify trends, and make data-driven decisions.
• General knowledge of NCQA HEDIS Technical Specifications.
• Knowledge of quality improvement theory, strategy, and practical methods to achieve rapid-cycle improvement.
• Ability to motivate superior team performance and contribute to building a strong team dynamic, when in-person and especially when collaborating from a remote workplace.
• Ability to creatively approach systems development and improvement.
• Ability to succeed independently in a fast-paced environment while managing significant projects with multiple priorities.
• Ability to efficiently and effectively manage time to prioritize responsibilities to meet the needs of all stakeholders as well as to meet project deadlines.
• Ability to travel within CenCal Health’s provider network region.
• Ability to establish and maintain positive professional working relationships, both within and outside CenCal Health.
• Ability to receive and provide effective, direct, and timely feedback to team members, including one’s supervisor and peers.
• Ability to evaluate data, establish facts, and draw valid conclusions.
• Ability to assume responsibility and exercise good judgment in making decisions within the scope of authority of the position.
• Excellent interpersonal skills and ability to effectively communicate organizational Vision, Mission, and Values to collaboratively lead and motivate teams to achieve superior performance.
• Self-motivated to seek knowledge to improve personal and professional performance.
• Effective oral and written communication skills.
• Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint.

Education and Experience

Required:

• Bachelor's degree in Healthcare Administration, Public Health, Nursing, or a related field.
• Three years of experience with a Medicare STAR Rating Program, including thorough understanding of STARS Program data submission requirements.
• Four years of experience in a Medicare managed care organization.
• Three years of experience managing audit relations with regulatory or accrediting bodies (e.g., CMS, NCQA).
• Three years of work experience in a leadership capacity.
• Must be proficient in creating and preparing reports and presentations.

Desired:

• Experience managing a STARS readiness program for a Medicare D-SNP.
• Master’s degree in a job-related field (e.g., MPH, MHA, MBA).
• Formal certification in areas of professional expertise(e.g., CPHQ, Six Sigma).
• Experience with HEDIS measure specifications and HEDIS Compliance Audit standards.