STARS Quality Specialist

Mass General Brigham•Somerville, MA

19h•Remote

About The Position

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage. Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise. We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more. The Quality STARS Specialist supports a clinical health plan's CMS Star Ratings performance by monitoring quality measures and translating data into actionable insights that improve care delivery, member experience, and outcomes. Partners with clinical, quality, pharmacy, provider, and operational teams to identify performance gaps, support outreach and care gap closure initiatives, and track progress across HEDIS, CAHPS, HOS, and related measures. Serving as a subject matter expert in Star Ratings methodology and analytics, supports regulatory compliance, audit readiness, program coordination, and process improvement to strengthen quality performance and operational effectiveness.

Requirements

Bachelor's Degree
At least 2-3 years of experience in a CMS STARs role, specializing in STARs program execution
At least 2-3 years experience managing STARs data, data validation, and outcomes
In-depth knowledge of healthcare regulations, accreditation standards, STARs program and quality improvement methodologies.
Strong understanding of document management systems (DMS), such as SharePoint, OpenText, or Documentum, to manage digital files, track revisions, and maintain version control.
Familiarity with cloud storage systems and collaboration tools like Google Drive, Dropbox, and Microsoft OneDrive.
Experience with electronic records management (ERM) and data retention policies.
Demonstrates awareness of importance of security, scalability, reliability and feasibility in solutions
Seeks out information to better understand impacts of design and implementation of systems
Evaluates service areas to identify opportunities for automation
Ability to draft, revise, and implement company policies and standard operating procedures.
Knowledge of compliance standards, including industry-specific regulations (e.g., healthcare HIPAA regulations, financial regulations, state and federal rules).
Strong organizational skills to ensure policies and documents are properly filed, categorized, and easy to access.
Ability to spot discrepancies or issues in documents and ensure compliance with required guidelines.
Understanding of legal and regulatory requirements for document retention and management, including data privacy and security laws.
Knowledge of audit procedures and the ability to prepare documentation for audits.
Excellent written and verbal communication skills for drafting policies and procedures, as well as providing guidance to employees about document handling and compliance.
Ability to train staff on document management practices and policy changes.
Experience using document management software and workflow tools to streamline document processes and improve efficiency.
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and other productivity tools is often required.
Familiarity with document control software for versioning, workflow management, and access permissions.
Ability to manage multiple tasks or projects simultaneously, adhering to deadlines and ensuring that policies and documents are up to date.
Strong critical thinking skills for analyzing policies and procedures to ensure they align with organizational goals and legal requirements.
Excellent interpersonal skills, including the ability to influence others at all levels of an organization.

Nice To Haves

Master's Degree
At least 5-7 years in health plan quality in a managed care organization
Experience in healthcare quality, STARs initiatives, population health, or related program coordination
Familiarity with QI methodologies and regulatory standards
Experience working with diverse communities or in community health, managed care, or hospital quality departments
Experience with SDOH screening tools, community partnerships, or health literacy initiatives
Certification in healthcare quality or equity (e.g., CPHQ, CPHE, Lean Six Sigma)
Experience with project management software, such as Trello or Microsoft Project

Responsibilities

Track performance on CMS Star Ratings measures across HEDIS, CAHPS, HOS, pharmacy, and operational metrics.
Prepare routine and ad hoc reports for leadership, quality teams, and operational partners.
Identify performance gaps using data analysis and recommend targeted interventions.
Maintain dashboards, scorecards, and measure level documentation.
A subject matter expert for the STARS analytics tool
Assist in developing and executing quality improvement initiatives to raise Star Ratings.
Support provider and member outreach campaigns aimed at closing care gaps.
Coordinate with clinical teams to ensure timely completion of preventive screenings, chronic condition management, and medication adherence activities.
Monitor progress of interventions and escalate issues when performance lags.
Work closely with departments such as Quality, Clinical Operations, Member Experience, Provider Relations, Pharmacy, and IT.
Support provider engagement efforts, including distributing measure education, performance summaries, and best practices.
Participate in internal workgroups focused on improving specific STARS measures.
Stay current on CMS Star Ratings methodology, technical specifications, and regulatory updates.
Ensure internal processes align with CMS requirements and audit expectations.
Assist with documentation for audits, mock audits, and compliance reviews.
Manage timelines, deliverables, and project tracking for STARS initiatives.
Support vendor coordination, including data exchange, reporting, and performance monitoring.
Maintain organized records of program activities, interventions, and outcomes.
Assist with annual planning for STARS strategy and operational execution.
Help design and execute outreach campaigns to improve member experience and close gaps in care.
Support provider education on measure requirements, coding accuracy, and documentation standards.
Coordinate distribution of materials, toolkits, and communications.
Identify workflow inefficiencies and recommend enhancements to improve measure performance.
Support implementation of new tools, processes, or technologies that streamline STARS operations.
Document standard operating procedures (SOPs) and maintain process guides.
Breaks complex topics into meaningful chunks of information.
Seeks out multiple sources to gather information.