Business Consultant - Stars Outcomes (Hybrid)

CareFirst•Baltimore, MD

12d•Hybrid

About The Position

The Business Consultant (Stars Outcomes) provides expertise in tailored, strategic, and critical work to help design, launch, and execute programs that support Medicare Advantage Stars initiatives in the changing healthcare environment. The Business Consultant (Stars Outcomes) will be responsible for an assigned set of 8-10 Star measures and is responsible for driving enterprise performance to 4 Stars for each measure, working with cross-functionable accountable areas. We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.

Requirements

Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
5 years experience in business development, operational technology support, general business operations and/or consulting experience.
Expertise in Medicare Advantage Star Ratings and HEDIS
Strong understanding of healthcare operations, Medicare Advantage, and member experience
Understands business goals and priorities
Follows evolving market, industry and consumer trends
Effective communication of complex ideas both verbal and written
Exceptional project management, facilitation and organizational skills
Excellent relationship management skills
Strategic thinker, problem solver, and a collaborator who can drive engagement and discussions
Significant experience with MS Office (Excel, PowerPoint, Word)
Must be eligible to work in the U.S. without Sponsorship

Responsibilities

Provide subject matter expertise in a Medicare Advantage Star Ratings that contributes to the effective accomplishment of initiatives tasks and goals
Leads governance and ownership for 8-10 assigned Star measures, managing 25-35 active interventions simultaneously.
Develops and tracks detailed project plans, monitors progress, proactively removes barriers.
Performance management including measure-level dashboards, identifying trends and risks, development of weekly executive level scorecards.
Supports ongoing Stars strategy development.
Develop presentations for committees, executive leadership, and stakeholders.
Identify "data gaps in care" and work with analytics team partners to drive improvement in clinical measurement.
Analyze member outreach performance across channels, including internal, vendor, and provider partners.
Evaluate outreach effectiveness and make recommendations for improvement.
Coordinate outreach efforts to minimize duplication and maximize gap closure.
Work with provider relations and value-based care teams to improve provider engagement in Stars work, including closing gaps in care, improving electronic clinical data submission, and help drive achievement of provider quality incentives.
Build trusted relationships within CareFirst to deepen subject-matter expertise, find opportunities to synchronize with core operations, and ensure close coordination with the central team in the execution of their areas of responsibility within the division.