Job description

• Lead development of programs/interventions designed to increase the plans overall Star ratings. This position creates and manages STAR workplan development and management in a matrixed cross functional environment aimed at identifying and addressing root causes of HEDIS, HOS, CAHPS measure performance.
• Manage STARs performance through creation of a centralized and coordinated dashboard of metrics from each contract and market.
• Create and display data to QI and plan leadership that will support identification of current performance, measures at risks, trend review and overall forecast of performances. This work will be at an aggregate plan level and individual contract level to support QI leadership resource allocation and communication of quality financial performance.
• Review and analyze data from all Markets to identify common performance themes and opportunities; develop central improvement programs that can be tailored and leveraged in each market. Collaborate with market level QI directors on improvement strategy and support market improvement opportunities.
• Synthesize data findings into performance reports, including tracking and monitoring for trends, to be shared with business owners and markets. Identify key findings and translate findings into business implications and areas of opportunity.
• Support root cause analysis and implement evidence based best practices that advance clinical quality and administrative measure performance and provide consultative support to key business stakeholders who influence HEDIS, CAHPS, HOS and STAR performance.
• Conduct evaluations of initiatives, feasibility of pilot programs for implementation across markets, research, and test effectiveness of process improvements to achieve sustainable quality performance goals. The assessment includes an end-to-end evaluation of the measure technical specification, performance trends, stakeholders, industry/research literature, organizational initiatives, associated policy and procedures, resources/tools. Identify opportunities for improvement and the corresponding return on investment.
• Act as a subject matter expert on STARs methodology, HEDIS measure specifications and quality improvement.
• Provide project management support on various improvement efforts focused on barriers to care for example: population health, health equity, and social determinants of health.
• Collaborate and Coordinate a wide variety of training to improve at the department level understanding of Stars and improve the culture of quality in the organization.
• Provide project management support on various improvement efforts focused on barriers to care for example: population health, health equity, and social determinants of health.
• No direct reports currently; however, one to three program consultants with future expansion.

• Standard office conditions. In office or hybrid working conditions.
• Position requires occasional travel in Massachusetts and the surrounding area.

• Bachelor's degree in business or health care related field.

• Master's degree

• Minimum 5-7 years of experience in healthcare, network performance and contracting, population health, quality improvement or related area
• Experience with CMSStars performance measures knowledge and experience required.
• Experience in health care data analytics and interpreting reports and translating data into actionable insights.
• Experience with Medicare Advantage, Medicaid; and dually eligible populations required.
• Experience in interpreting data and formulating recommendations/action plans to support network population health, quality, health equity, and social determinants of health improvement
• Experience leading and managing cross-functional projects and project teams

• CPHQ

• Understanding CMS Stars program methodology and quality bonus program
• Ability to communicate quality improvement concepts and tasks to cross functional teams and with external stakeholders, including network providers
• Excellent ability to cultivate and maintain interpersonal and professional relationships across various teams and external provider partners
• Self-directed and able to plan, organize, and execute work with minimal supervision
• Ability to communicate business and technical information to people of various backgrounds
• Strong project management skills

• CPHQ

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