The Program Manager of the Star Quality Program for Senior Products (SP) is responsible for achieving a 4+ Star rating across all contracts by monitoring and evaluating programs in collaboration with domain measure owners. This dynamic individual will work closely with business leaders and domain owners across SP to implement programs, measure results, facilitate and coordinate plans to improve measure and/or domain performance. The Program Manager will serve as the in-house expert on the Star program for all internal and external stakeholders. In this highly-visible role, the Program Manager will be required to communicate effectively with the President and VPs of SP, Medical Directors of provider groups, and vendors supporting the Star program.Job Description
- Manage the programmatic oversight and facilitation of the Star Quality program across multiple Medicare Advantage (MA) contracts across multiple states. Working with cross-functional teams and individual stakeholders, the program manager will:
- Monitor and evaluate programs and initiatives at the Star measure and domain level across each MA contract in collaboration with the Star Stakeholders
- Implement new programs and processes to support with performance improvement , both at the measure and domain level
- Manage Star program dashboard and provide high-level summary for reporting to SP leadership
- Serve as the in-house expert on the Star program for internal and external stakeholders by:
- Staying up-to-date on the changes to the Star program both, proposed and anticipated
- Collaborating with stakeholders to implement new programs to proactively plan for the change
- Identify opportunities and advocate for resources and/or tools to SP Leadership
- Lead monthly meetings with various managers and measure-owners to discuss progress and understand barriers to performance
- Responsible for developing agenda, materials, and follow-up communication for Star Stakeholder and Star Steering meetings in collaboration with the Senior Star Analyst and Director
- Research and share recommendations with the Star team and stakeholders on effective/proven best practices from literature and online review, newsletters, webinars etc.
- Oversee development and implementation of an annual proxy survey for HOS and CAHPS across multiple contracts
- Support companywide awareness and understanding of the value of a high Star Ratingthrough ongoing education, presentations, and employee engagement
- Monitor progress of provider performance improvement action plans in collaboration with the THP Medical Directors
- Collaborate with Sr Star Analyst to monitor performance trends and other data insights
- Lead development and updating of a provider contact directory to be utilized by diverse Star Stakeholders (HEDIS, Pharmacy) for sending pertinent performance data and reports
- Evaluate vendors to improve existing Star performance, for Mass, CT, and other states, as necessary
- Perform other duties as necessary
- Bachelor’s degree in health related field required, Advanced degree such as MPH or MBA preferred
- 7 – 9 years related work experience in managed care industry
- Project management and process improvement experience required
- Strong analytical skills also a requirement
- Experience with Government QI programs or similar clinical or quality program management preferred.
- Advanced proficiency with Microsoft Office Suite (Word, PowerPoint, Excel)
- Lean orSix Sigma certification or other process improvement training preferred
- Passion for quality improvement with a collaborative attitude
- Must be a champion of change, able to conceptualize and envision the impact of change, and propose new ways to achieve a high performance
- Strong verbal, written, and presentation skills
- Strong interpersonal and communication skills
- Excellent organizational skills and ability to successfully manage multiple priorities and tasks.
- Demonstrates self-direction, high-level of initiative, and a high level of motivation
- Must be able to work both independently and as part of a team
- Must have the ability to influence and motivate stakeholders by fostering team spirit, an attitude of cooperation, and a commitment to excellence
WORKING CONDITIONS AND ADDITIONAL REQUIREMENTS:
- Fast paced office environment handling multiple demands.
- Must be able to exercise appropriate judgment as necessary
- May require occasional evening or weekend hours based on the needs of the organization
- Requires that the individual be organized while being readily adaptable to changes in work priorities.
- May require occasional travel out of state to business partner site, provider meetings, or attendance at conferences
CONFIDENTIAL DATA: All information (written, verbal, electronic, etc.) that an employee encounters while working at Tufts Health Plan is considered confidential. Exposed to and required to deal with highly confidential and sensitive material and must adhere to corporate compliance policy, department guidelines/policies and all applicable laws and regulations at all times.
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