job

About Us:

Santa Clara Family Health Plan (SCFHP) is a local, community-based health plan dedicated to improving the health and well-being of the residents of Santa Clara County. Working in partnership with providers and community organizations, we serve our neighbors through our Medi-Cal and SCFHP DualConnect (HMO D-SNP) health care plans.

About the role:

The Stars Program Manager is responsible for developing and executing a strategy to improve the CMS Stars rating performance for Santa Clara Family Health Plan. This role serves as a critical resource and subject matter expert in supporting, monitoring, managing, and driving strategic projects, interventions, and initiatives for the organization’s Medicare Star Rating program.

This is a highly collaborative role that partners with internal teams across the company, external vendors, and healthcare providers to ensure our programs are achieving our goals. The role uses a variety of data sources to determine performance across current and emerging STARS measures, identify insights and opportunities for performance improvements, and share these findings with stakeholders to drive continuous improvement. This position reviews and accurately interprets complex regulatory documents, including STARS measure specifications from CMS and measure stewards. This position will lead and present material at internal and external meetings, develop and conduct training on STARS-related topics, assist in regulatory comment development, help drive goal setting, help prioritize interventions, and develop/maintain STARS Program-related documents.

Day to Day:

Implement strategies and initiatives on the Stars Tactical work plan, including managing projects of varying degrees of complexity (i.e., administration of CMS surveys, Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey, Health Outcomes Survey (HOS), multi-channel member outreach, provider education, off-cycle surveys, and prescription drug event reconciliation).

Independently produce and manage prospective quality reports with analysis to manage program performance, support rating predictions, and support meetings with delegates, provider groups, and internal stakeholders.

Interpret and organize information around current performance, historical trends, predicted performance, and opportunities for improvement (including opportunities relative to competing plans in the market) within the context of Stars and assigned Medicare contracts.

Support upkeep of Stars dashboard(s) by managing files and data feeds, maintaining and updating data tables that support dashboards, and performing monthly data validation in collaboration with other stakeholders.

Provide comprehensive analysis of measures, barriers, and opportunities, and present results of improvement efforts and ongoing performance measures to management.

Serve as the subject matter expert (SME) on Stars for each assigned contract, including the measures that apply to each contract and the organization’s strategy for achieving the highest possible rating for each contract, and reviewing CMS communications and staying abreast of changes to Star program rules, measures, and/or measure specifications

Manage current quality initiatives, collaborate and educate SCFHP staff, provider network and community partners on how to improve SCFHP Star Program.
Perform other related duties as required or assigned.

About You:

Bachelor’s Degree in Management, Business, Healthcare, or a related field, or equivalent experience.

Minimum three years of experience with quality improvement in health related setting, including performing root cause analysis, Plan Do Study Act methodology and monitoring/analyzing improvement, program development.

Knowledge of Medicare principles and practices with emphasis in quality improvement.

Proven ability to design and execute strategic plans for continuous improvement initiatives.

Medicare Stars experience.

Experience leading cross-functional projects.

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