Senior Director Star Ratings & Quality Center of Excellence - Remote

Prime Therapeutics•Home, WV

22d•$143,000 - $243,000•Remote

About The Position

The Government Programs Senior Director Star Rating and Quality Center of Excellence (COE) is responsible for leading strategy development and executing all services and programs designed to improve key quality related measurements for Medicare and Managed Medicaid. This role leads a Star and quality team in identifying and developing core tools, resources, and technology to drive Star Ratings performance and quality metrics. Leads Center of Excellence workgroup to collaborate with key internal and external partners and vendors to create innovative offerings to drive Medicare Star Ratings that earn clients’ Medicare Advantage quality bonus payments, increase affordability / reduce the total cost of care for members and clients, and enables membership growth for our clients.

Requirements

Bachelor’s degree in business, health services or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
10 years of work experience in Medicare Star Rating quality programs, analytics, audit, compliance, operational compliance, or related field
7 years of leadership/people management experience
Must be eligible to work in the United States without need for work visa or residency sponsorship
Must be eligible to work in the United States without the need for work visa or residency sponsorship

Nice To Haves

Strategic planning and execution
Excellent written and verbal communication skills with the demonstrated ability of presenting program and project updates to senior executives
Strong organizational, analytical, interpretative, and time management skills
Strong interpersonal skills including team leadership and collaboration
Understanding of CMS Star Rating regulatory requirements / technical specifications
Strong commitment and proven track record of continuous quality improvement
Demonstrated ability to identify and develop quality programs and process improvements
Experience working with cross-functional partners both internally and externally
Experience with analytical tools such as Excel, Access data bases, SaaS
Strong client consulting presence: ability to distill complex material into easy to understand presentations, effectively respond to questions and engage a variety of audiences
Ability to communicate effectively with senior leaders across the organization

Responsibilities

Formulate strategic and tactical plans, processes, and tools relative to the highest standards of quality; establish and maintain quality procedures and processes that drive Star ratings and measurable results.
Develop a comprehensive Medicare Star Ratings and CAHPS strategy that meets the needs of clients to attract and retain members and achieve quality bonus payments.
Lead cross-functional Star / Quality COE workgroup and steering committee with key internal partners such as clinical programs, member experience, and data/analytic to drive synergies related to quality improvement and new product / program development for Prime’s Government Programs book of business. Provide strategic consultation and solutions to our clients that delivers on client’s strategic objectives.
Lead team of quality managers and data analysts, to provide work direction, budget, performance and development, resource planning, and consistently demonstrate Prime’s leadership expectations during interactions with direct reports, cross-functional and external stakeholders.
In partnership with Compliance and Government Affairs, ensure proactive monitoring/tracking, review, and response to proposed regulatory policy and contract obligations as applicable to Medicare Star Ratings and other quality program changes. Interact with key industry quality leaders and position Prime as a leader in this space through measurable and sustained year over year results / improvement.
Develop, implement, manage, and maintain tools, technology, and processes to support Star rating and quality performance.
Lead competitive market analysis and identify new trends and opportunities to inform Star rating and quality strategy and position Prime for growth.
Participate in GP Strategy and other workgroups to integrate quality / Medicare Star Ratings lens into our daily work looking for ways to drive efficiency, improve processes, and enhance member experience in alignment with the Centers for Medicare & Medicaid Services (CMS) program requirements.
Develop quality specific data needs / solutions for Star Rating performance management and insights development. Partner with enterprise data and analytics team to enhance tools and capabilities to drive efficiencies and flexibility for client specific needs. Represent Prime Quality Programs in RFP responses, at industry conferences, and at current and prospective client / finalist meetings.
Other duties as assigned.