Director, Medicare STARS

SF Health Plan • San Francisco, CA

1d • $176,000 - $209,000 • Hybrid

About The Position

Reporting to Sr. Director, Product and Growth, the Director, Medicare STARS develops health plan strategy. SFHP aims this strategy execution at achieving its quality, operational, and administrative goals for the Medicare D-SNP product. You will also support other projects that influence STARS ratings. You will lead with functional leaders to design and implement Medicare STARS strategies across the organization to achieve improvements in the Plan's CMS STAR Ratings measures. To influence and provide direction in a matrixed team structure, you must develop working relationships with key team members across the organization, contracted vendors, network providers, and the Health Services teams. The goal of these relationships is to ensure STAR ratings are achieved and maintained for SFHP. The Director, Medicare STARS will improve strategy and outcomes and will lead a governance committee with functional leaders and the executive leadership team to ensure the advancement of Medicare STARS Program priorities. Your role will involve a blend of strategic planning, performance monitoring, team member engagement and regulatory compliance to meet the plan's STARS ratings goals. Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office. Salary: $176,000 - $209,000 per year

Requirements

• 7 or more years of current progressive, operational experience in a health plan or managed care setting with a focus on excellent process and execution.
• We require prior experience driving and leading. This experience is in a non-integrated healthcare setting consisting of diverse provider types, including solo, small, and medium-size practices, and IPA's.
• Specifically, this experience should involve rolling out, implementing, and achieving at least a 4-STAR Medicare or Medicare Advantage STARS Rating.
• 7 years of proven senior level leadership/management experience.
• Bachelor's degree in public health, business or other related fields from an accredited institution or equivalent work experience
• Experience of the principles and practices of Medicare STAR Rating, including data analysis and trends.
• Experience with Health Plan Part C requirements includes staying health equity index and healthy measures.
• Additionally, it involves managing chronic long-term conditions, and ensuring a positive member experience and addressing member complaints and customer service issues.
• Experience with Health Plan Part D requirements including drug plan customer service, member complaints, member experience, and drug safety and accuracy of drug pricing.
• Specific operational understanding of the differences in achieving a 4-STAR rating in an integrated vs. a non-integrated healthcare system.
• Knowledge of current regulatory requirements for Part C/Part D measures.
• Knowledge of CAHPS, member experience, health equity index (HEI) and access measure performance.
• In-depth knowledge of coding and documentation training programs for the provider network to support Medicare STAR measure performance.

Nice To Haves

• Master's degree or higher in healthcare administration, nursing, hospital administration, business, public health, or related field from an accredited institution.

Responsibilities

• Set strategic direction, goals, and prioritize goals/performance targets for the Medicare STARS team.
• Plan, develop, and implement improvement strategies to achieve performance goals for Medicare Part C and D STARS measures.
• Survey the competitive landscape and industry leaders, identify best practices and monitor industry quality and member engagement trends.
• Share this information with the team to inform STAR improvement efforts.
• Guide positive culture transformation and corporate-wide awareness of STARS through education, communication, and employee engagement.
• Lead annual STARS strategy planning process, setting clear goals and performance targets.
• Be a Subject Matter Expert (SME) on CMS STARS program requirements, to provide guidance and interpretation to SFHP staff.
• Lead and implement Medicare STARS measure performance analytics with an aim to identify areas of opportunity, important drivers that impact ratings, and assess the impact of quality improvement activities on measure performance.
• Analysis should include HEDIS, CAHPS, HOS and other quality measures to assess progress.
• Monitor the effectiveness of quality and Medicare STARS projects to ensure teams deliver the agreed upon projects.
• Work with teams to modify and adjust approaches to outcomes.
• Create visibility into issues and required resources and ensure that we include projects targeting STAR measure improvement in business planning and budgeting.
• Lead development of dashboards and reports to communicate STARS performance to functional leads and senior leadership.
• Ensure that the STARS program complies with CMS guidelines, quality standards and reporting requirements.
• Support oversight of the operations of each department for compliance with all regulatory requirements.
• Oversee the submission of complete and accurate data to CMS and other regulatory bodies.
• Stay current with CMS guidelines, STARS methodology changes, and latest trends.
• Update projections and strategic focus to improve STARS ratings.
• Develop relationships with the SFHP Provider Network team to communicate new requirements and opportunities around clinical workflow, data reporting, and support services to improve quality outcomes, including SFHP Pay for Performance results.
• Partner with teams to develop and implement member outreach programs to promote preventive care and health screenings.
• Lead and influence decisions to meet organizational goals; develop and implement strategies to build organizational knowledge and fluency in Medicare STARS.
• Guide and partner with departments in accomplishing STARS improvement strategies.
• These strategies include developing new STARS performance improvement projects, managing and standardizing existing STARS improvement projects, evaluating and optimizing programs to improve STARS reporting and compliance.
• Influence thought leadership regarding measure level improvement opportunities and serve as a subject matter expert in meetings and discussions.
• Lead teams to implement Medicare STARS measure level improvement interventions across all categories of the STARS Program and partnering with both internal and external resources.
• Perform any other tasks to ensure Health Plan operations and department needs are successful.
• Represent STARS program in executive meetings and team member discussions.
• The SFHP Team is committed to incorporate SFHP's Quality Program goals including HEDIS, CAHPS, and NCQA Accreditation.

Benefits

• Health Benefits
• Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
• Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
• Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
• Retirement Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

What This Job Offers

• Job Type: Full-time
• Career Level: Director