Star Rating Manager

  • January 13, 2017
  • Triple-S Salud
  • TBD
  • TBD

Job nature

The Star Rating Program Manager is responsible for developing and administering innovative strategies for the Star Rating System for Medicare Advantage Plans as determined by CMS. Will lead to support and oversee corporate strategies.The Star Rating Program Manager is responsible for developing and administering innovative strategies for the Star Rating System for Medicare Advantage Plans as determined by CMS. Will lead to support and oversee corporate strategies.

Essential Functions

Ensure that processes needed on the performance of Stars Rating are established, implemented and maintained. Promote innovation and ideas to achieve Stars Rating. Proactively identify performance improvement opportunities through analysis of key metrics and discussion with subject matter experts. Ensure implementation of activities to comply with Plan Domains related to Stars Rating. Promote compliance with quality and outcome measures that relate to Stars Rating. Emphasize transparency and stable methodology to achieve Stars measures. Stay updated on changes in specifications and regulations assess potential impact on the organization Star Rating and maintain management staff informed. Oversee implementation of changes to methodology of measures tied to Stars Rating. Analyze trends and identify areas of opportunities to improve results. Data entry of statistics, validate Stars assignment and maintain Star Rating Corporate Dashboard Report. Report to management on the performance of activities to comply with Stars Rating and any need for improvement. Administrate businesses related to Star Rating Committee and work groups. Liaise with Finance Department and Network Management Department on matters related to Bonus Payment tied to Stars Ratings. Liaise with corporate departments on all matters related to Stars Rating, including but not limited to Stars Rating education. Travel across assigned territory to meet with providers to discuss improvement opportunities. Lead cross-functional teams, plan and coordinate their work plan to ensure that goals are achieved. Design, develop and create performance reports for Management, including measure’s trend analysis and star rating projections. Research and benchmarks industry performance and best practices. Oversee the compliance of vendors related to Star Rating Program initiatives. Cross training within the Department. Contribute and cooperate in any business matter related to the Quality and Star Programs Department.

Minimum Requirements

Bachelor Degree in Business Administration, Arts, Science, Public Health preferably. With five (5) years of experience in process improvement, implementation of quality programs, health services administration and/or HEDIS Audit/Medicare Advantage STAR Rating Program. Financial/Auditor/Statistical/Analytical background within Medicare Advantage is a plus. Or Associates Degree (60-64) college credits with at least 7 years of the experience mentioned above. Or 9 years of this experience in lieu of.

Key Competencies

Medicare Advantage business, advance statistics and computer management knowledge. Strong organizational and time management skills, experience with quality improvement efforts, project management skills, communicate effectively with multidisciplinary clinical team, track monitoring activities accurately, work independently and take initiative. Demonstrate knowledge of statistics, data collection, analysis, data presentation and present in front of large group of staff and external audiences. All employees are expected to support actively the metrics / indicators that will facilitate the accomplishment of the corporate and departmental objectives. In any opportunity during the performance of the tasks, the employee should: Maintain the minimum professional criterion of the job, complete all required trainings, and show commitment with compliance of Company’s policies and procedures. Treat all people with respect, assuring to provide an excellent service to our policyholders, participants, providers and clients, as well as with any employee or supervisor. Maintain composure in highly stressful or adverse situations. Maintain confidential the protected information which might have access as part of the job.

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