Stars Performance Senior Manager - Monitoring Analysis & Improvement
As the US Healthcare system transitions from volume to value based payment models, health plans are increasingly measured and rewarded for their performance on Quality Programs. The Government Services Quality Programs team at CVS Health plays a critical role in ensuring that our Medicare health plan clients and SilverScript, a prescription drug benefit plan owned by CVS Health that serves over 4 million members, achieves superior performance on the highly visible and impactful Star Rating program.
As the Stars Performance Senior Manager, you will have full management responsibility for developing the strategic objectives, standards and methodologies for allocating the budget to support the organizational initiatives that improve and maintain top-notch Star Ratings.
You will be accountable for the performance and results of the Stars program for Silverscript and Caremark clients. You will partner with and influence a wide set of internal and external partners at all levels of leadership, including Operational business owners, Account Managers, Product Management, and key client organizations, to drive and track initiatives focused on improving or maintaining Star Ratings. You will need to adapt plans and priorities to address resource and operational challenges.
You will also lead a team of professional employees to identify and resolve challenges. You will deliver recommendations regarding organizational remediation in operational and clinical areas to improve the overall Star ratings performance.
You will have a significant impact on the quality of the Stars team’s work and the organization’s ability to achieve government performance goals.
As the Stars Performance Senior Manager, you will apply your understanding of the industry, the Stars program and the CVS Health organization to serve as an expert both internally and externally.
This position will require an ability to develop in-depth understanding of concepts, theories and principles as it pertains to Government Performance Measures and the PBM industry.
In this capacity, you will provide support to Caremark's Sales and Account Services division and our clients regarding Star ratings performance, regulatory changes and on-going improvement initiatives.
You will review new requirements as published by CMS and PQA (Pharmacy Quality Alliance) and manage interpretation and communication of the required changes throughout the cross-functional business units impacted by the CMS mandated changes to the Star Ratings.
You will be actively engaged with leadership within the Medical Affairs and Clinical Services teams to facilitate communication and collaboration on Stars initiatives.
You have the ability to work with and influence cross-functional partners to implement new requirements to achieve/maintain high performance.
You will also be responsible for, and measured against, the following primary objectives:
- Stars Performance Governance and Accountability - Establish organizational alignment and accountability to achieve > 4 Star Performance for Silverscript and increase Medicare Clients achieving 4+ Stars to 55% of Clients and 80% of lives under management
- Performance Reporting/Monitoring - Ensure that the organization has timely, accurate visibility into Stars performance for Silverscript and our clients
- P&L Management - Lead oversight and management of Stars Initiative Budget (~$13M) to ensure investments generate maximum impact on Stars performance and that actual spend is within 2% of forecast
- Analytics - Provide insights to get results, as well as develop best-in-class tools to project and forecast Stars performance
- Policy - Craft the evolution of quality through advocacy
- Client Growth and Retention - Win new clients and grow services with existing clients by differentiating CVS Health ability to support their quality goals
As a successful Senior Manager, you will possess the ability to provide project management leadership and to take complex business issues and requirements to recommend solutions independently.
You will develop a track record in building consensus and cultivating relationships with internal and external technical and business staff. You will need your extraordinary written communication, oral communication, and presentation skills in order to strategically plan, organize, and time manage.
You will be required to have impeccable attention to detail, with excellent social and harmonious skills. Finally, you should successfully be able to work cross-functionally to implement new requirements and creative solve problems where standard resolutions do not exist.
The contributions you will make as a Stars Performance Senior Manager will position CVS Health as a leader in client satisfaction and service in the PBM marketplace.
* 9+ years of demonstrated leadership experience within project management, strategy, or a similar field, within a highly regulated industry.
* 5+ years of client relationship management experience, including the demonstrated ability to analyze and resolve client issues.
* 5+ years of experience gathering business requirements, with a strong understanding of a technical process flow and complex requirements.
* 3+ years of advanced-expert level experience using the Microsoft Office Suite, specifically with Excel, Power Point, Outlook, Word, and Project.
* Must have the ability and flexibility to travel up to 25%.
* Direct PBM experience is preferred.
* Previous experience with Star Ratings/Quality Assurance is desired.
Bachelor's degree is required; equivalent work experience may substitute.
MBA is preferred.
Job ID: 620224BR.