Program Manager, Medicare Stars & Quality Improvement

About the Role

Provides subject matter expertise and leadership for Medicare Stars quality improvement (QI) programs and activities. Leads and manages Medicare Star projects and programs involving enterprise, department, cross-functional, and health plan teams to deliver impactful quality improvement initiatives from design through completion and outcomes measurement.

Responsibilities

• Collaborates with cross-functional corporate and health plan teams on the development and implementation of enterprise Medicare Stars quality improvement (QI) programs and initiatives.
• Manages, plans, and executes Medicare Star ratings programs, including supporting Stars program execution and governance needs.
• Serves as the Medicare Stars subject matter expert to corporate functional areas and health plans, leading programs to meet critical needs.
• Communicates and collaborates with health plans and Stars measure owners to analyze and transform needs and goals into functional requirements for maximizing improvement opportunities.
• Leads health plan leadership discussions to provide recommendations, performance results, and opportunity assessments for Medicare Stars improvement.
• Collaborates with operational leaders to recommend process improvements, organizational change management, and program management related to Medicare Star ratings.
• Facilitates process improvement, organizational change management, and program management relative to the Medicare Stars Program.
• Plans and directs schedules for program initiatives, including program budgets.
• Develops, defines, and executes plans, schedules, and deliverables; monitors programs from initiation through delivery and outcomes measurement.
• Monitors and tracks key performance indicators (KPIs) to reflect the value and effectiveness of Stars and QI programs.
• Creates business requirements documents, test plans, requirements traceability matrix, user training materials, and other related documents.
• Generates and distributes quality improvement and Medicare Stars standard reports in a timely manner.
• May engage and oversee the work of external vendors.

Requirements

• At least 6 years of Medicare Stars program and project management experience, or equivalent combination of relevant education and experience.
• Demonstrated knowledge of and experience with Medicare Star ratings and QI programs.
• Advanced knowledge of the quality discipline, including metrics and performance standards.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• Experience developing performance measures that support business objectives.
• Strong strategic-thinking and project management skills.
• Proficiency with data analysis, manipulation, interpretation, reporting, and data-driven decision-making.
• Critical-thinking, problem-solving, and analytical skills.
• Attention to detail and strong organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Ability to work in a cross-functional, highly matrixed organization.
• Excellent verbal, written, and presentation communication skills.
• Proficiency in Microsoft Office suite (including Excel) and ability to learn new information systems and software programs.

Preferred Qualifications

• Strong Medicare Stars/quality improvement (QI) program experience.
• Six Sigma Black Belt Certification.
• ITIL (Information Technology Infrastructure Library) certification.
• Experience in leading significant cross-functional work.

Pay

Pay Range: $65,791.66 - $142,548.59 per year. Actual compensation may vary based on geographic location, work experience, education, and/or skill level.