Manager, Quality and Stars, Health Plan
About The Position
The Manager, Quality & Stars is responsible for identification, development and implementation of strategic programs with significant focus on Health Plan ratings and performance monitoring for governmental agencies, including CMS Star Ratings and BadgerCare HMO Pay-for-Performance. This position works collaboratively with internal teams, provider partners and vendors to develop implement and monitor continuous improvement plans that includes programs, services and tactics to allow the Health Plan to lead the industry in quality programs designed to improve member experience and clinical outcomes. This strategic leadership role oversees the organization's value-based performance, with a primary focus on the CMS Medicare Star Ratings program, BadgerCare Pay-for-Performance, and NCQA technical specifications. The individual is responsible for the end-to-end management of the Stars Program, from analyzing regulatory guidance and identifying performance risks to implementing tactical work plans and dashboards that track intervention success. By collaborating across departments and with data analytics partners, they drive improvements in clinical care, provider engagement, and member communication to maximize quality scores and ensure compliance with evolving federal requirements. In addition to technical and analytical oversight, the position serves as a central subject matter expert and people leader. The individual is responsible for educating the organization on the financial and operational impacts of improved ratings, managing external vendor relationships, and presenting performance strategies to senior leadership. As a manager, they are tasked with coaching, mentoring, and developing their team, ensuring staff are well-equipped to navigate complex quality rating systems like the Marketplace QRS. Additional duties as assigned.
Requirements
- Bachelor’s degree in business administration, healthcare administration, or related field required.
- Five years of experience in managing quality or performance in the payor or provider space, required.
- Demonstrated outcomes and knowledge of reporting and analysis of healthcare related data.
Nice To Haves
- Masters degree preferred.
- Experience in project management in healthcare industry and/or experience in health plan quality performance and ratings, preferred.
Responsibilities
- Identification, development and implementation of strategic programs with significant focus on Health Plan ratings and performance monitoring for governmental agencies, including CMS Star Ratings and BadgerCare HMO Pay-for-Performance.
- Works collaboratively with internal teams, provider partners and vendors to develop implement and monitor continuous improvement plans that includes programs, services and tactics to allow the Health Plan to lead the industry in quality programs designed to improve member experience and clinical outcomes.
- Oversees the organization's value-based performance, with a primary focus on the CMS Medicare Star Ratings program, BadgerCare Pay-for-Performance, and NCQA technical specifications.
- Responsible for the end-to-end management of the Stars Program, from analyzing regulatory guidance and identifying performance risks to implementing tactical work plans and dashboards that track intervention success.
- Drives improvements in clinical care, provider engagement, and member communication to maximize quality scores and ensure compliance with evolving federal requirements.
- Educates the organization on the financial and operational impacts of improved ratings.
- Manages external vendor relationships.
- Presents performance strategies to senior leadership.
- Coaches, mentors, and develops their team, ensuring staff are well-equipped to navigate complex quality rating systems like the Marketplace QRS.
- Additional duties as assigned.
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What This Job Offers
Job Type
Full-time
Career Level
Manager
