Manager, STARS Member Experience (52646)

GLOBALHEALTH HOLDINGS LLC•Oklahoma City, OK

2d•Remote

About The Position

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer that aims to be the employer of choice in its industry. The company focuses on providing high-touch, high-value, and partnership-based services to its members, offering affordable health insurance coverage with desired benefits. GlobalHealth seeks employees who embody core values of accountability, ownership, drive, innovation, and a passion for continuous learning. The Manager, STARS Member Experience will provide guidance and training to the Quality department and organization-wide staff on member experience improvement initiatives, ensuring effective management of member experience survey ratings and member/provider outreach.

Requirements

Bachelors degree or equivalent experience required.
5-years experience in a clinical or health insurance setting required.
5-years experience managing data to create reports required.
Requires a valid state Drivers License.
Ability to communicate and manage complex working relationships.
Ability to train internal and external parties.
Strong organizational, verbal, written, time management, and telephone skills.
Computer literate and familiar with Microsoft applications (Word, Excel, Outlook).
Basic electronic health record knowledge and ability to quickly learn new software.
Detailed knowledge of quality performance measures and clinical health care.
Ability to collaborate across departments.

Nice To Haves

Experience in medical quality, marketing, risk adjustment, coding, and/or wellness preferred.

Responsibilities

Develops, plans, and implements initiatives and other quality member experience improvement strategies, making recommendations for change as needed.
Directs the member experience processes to ensure the health plan is NCQA-accredited and is a 4+ STAR rating.
Ensures pre-CAHPS member surveys are fielded on a monthly basis and communicates results with external provider groups.
Builds and maintains relationships with other departments internally, as well as external provider groups, as it relates to STARS and NCQA.
Implements survey improvement initiatives including CAHPS committee meetings to ensure company-wide involvement to increase member survey scores.
Creates wellness materials for marketing distribution to aid in member retention and health improvement efforts.
Maintains an expert technical understanding of HEDIS, CAHPS, HOS, NCQA and Meaningful Use measures set by CMS performance standards.
Manages and monitors performance for CAHPS/HOS survey vendor.
Develops and implements Medicare AWV/HRA program to increase provider and member participation.
Sets actionable and achievable goals for Quality Department implementation toward earning and maintaining a 4 STAR.
Creates training material on member experience surveys for organization-wide staff.
Maintains confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
Performs other duties as assigned.