Manager, Stars & Quality - Medicare Advantage Plans

Why BayCare?

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility and clinical excellence.

Summary:

• Responsible for developing and executing a quality improvement strategy to include maintaining or improving the CMS Stars rating performance, operations, projects and planning for quality improvement programs.
• Management of the HEDIS and Quality Data team involved in analyzing, monitoring, reporting, and providing technical collaboration.
• Oversees quality needs of the health plan including HEDIS, NCQA, and STARs.
• Reviews and accurately interprets complex regulatory documents, including STARS measure specifications from CMS.
• Leading the development and execution of respective plans in relation to survey preparedness and response while advancing the capabilities of the management staff and PHSO collaboration to execute these concepts.
• Works directly with health plan leadership and the population health services organization to maintain appropriate certifications and support efforts for any additional program certification expansion.
• Manage current quality initiatives, collaborate with PHSO for provider network and community partners on how to improve Star Program.
• Serve as the subject matter expert (SME) on Stars for including the measures that apply to the organization's strategy for achieving the highest possible rating and reviewing CMS communications and staying abreast of changes to Star program rules, measures, and/or measure specifications.

Minimum Qualifications:

Education:

• Bachelor's Degree - Related Field

Experience:

• Three years of experience in a Medicare Advantage health plan with Stars performance leadership, HEDIS, quality improvement.

Facility: BayCare Health System, Finance-BHS

Location: Park Place - Clearwater

Status: Full Time, Exempt: Yes

Shift Hours: 8:00 AM - 5:00 PM

Shift: Shift 1

Shift 1 = Days, 2 = Evenings, 3 = Nights, 4 = Varies

Weekend Work: Occasional

On Call: No

How often will this team member be working remotely? Hybrid

Equal Opportunity Employer Veterans/Disabled