Quality Stars Program Coordinator

The Health Plan of West Virginia Inc • Wheeling, WV

6h

About The Position

Under the leadership and direction of the Vice President Quality Improvement, the Quality Stars Program Coordinator will focus on the clinical operations for Medicare Star initiatives and other quality improvement initiatives that interface with Clinical Services, Pharmacy, Quality Improvement and the Medical Economics Departments. This position is responsible for data analysis and reporting to identify trends, gaps in care, and opportunities for improvement. Conducts outreach to members and providers to improve adherence to measures. Reviews and analyzing member and provider complaints along with survey results to improve outcomes. Interfaces with the Provider Operations and Provider Experience teams for quality provider initiatives and provider education. See job description attached.

Requirements

• Bachelor's degree or equivalent healthcare industry experience (five years).
• Minimum of two years of experience related to any of the following: Managed Care, Medicare Stars, HEDIS, CAHPS, HOS.
• Has the ability to prioritize and pivot to achieve goals with minimal supervision.
• Ability to build working relationships with internal staff and external stakeholders including community and vendor partners.

Nice To Haves

• Medicare Star Ratings experience with the ability to analyze and interpret cut point predictions.

Responsibilities

• Works with VP, Quality Improvement and Clinical Quality Stars Program Manager to learn and apply the Medicare Part C&D Star Ratings Technical Notes.
• Communicates with the Medical Economics Department and the Clinical Quality Stars Program Manager to obtain ongoing HEDIS and Stars data collections to support SMART goals.
• Works with internal departments to identify opportunites for improvement, gap closure and facilitates the development of member and provider clinical data driven initiatives to promote optimal member outcomes and provider best practices.
• Assists with tracking systems for reporting KPIs for the evaluation of activities and the effectiveness related to program initiatives and other performance/quality improvement projects.
• Interfaces with the Provider Operations and Provider Experience teams for quality provider initaitives and provider education.
• Using the PDSA cycle, identifies barriers and opportunities for improvement related to Star ratings, NCQA, CAHPS and HOS surveys and other member experience or quality metrics.
• Assists to development training and educational material that directly impacts quality initiatives.
• Participates in quality improvement meetings and committees/subcommittees and focus groups.

What This Job Offers

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