Description

Resp & Qualifications

PURPOSE:
We are looking for an experienced Medicare Advantage Stars/Quality professional to work remotely from within the greater Baltimore/Washington DC metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. The Stars Project Manager is responsible for development and execution of operational processes and key results related to the organization's Star Rating improvement goals across the assigned Medicare Advantage (MA) products. Plans, organizes, and manages large scale and complex Quality Improvement projects for successful delivery of objectives, on time and within budget. Initiates, engages, and motivates cross-functional teams to deliver results. Identifies and mitigates risk and escalates as needed. Tracks progress and drives documentation to support project needs. Ensures end to end leadership for implementations, integration, business readiness and communications.

ESSENTIAL FUNCTIONS:

• Plans and manages end to end processes, execution of strategy, and vendor relationships across all CMS Medicare Advantage Star Rating domains. Helps develop and execute on Stars Work Plan, including Pharmacy, CAHPS/HOS, Operational Excellence, and HEDIS improvement.
• Develop, manage, and communicate goals and metrics for monitoring the progress of the Stars Program across MA products to optimize Star improvement action plans, activities and outcomes related to member's healthcare.
• Conduct impact analysis and formulate actions related to regulatory changes and implement appropriate changes and process improvements to drive CareFirst plans toward 4+ Star outcomes. Collaborate across the eco-system such as CMS, BCBSA, etc. to support necessary regulatory improvements to enable optimal Star Ratings. Serve as an SME to guide the key stakeholders in bid filings and plan performance strategies and actions.
• Provides direction and motivation to project teams in a matrixed environment. Drives outcomes by fostering a collaborative culture. Manages relationships with key stakeholders, including management and vendors. Leads the execution of the project.

SUPERVISORY RESPONSIBILITY:
This position has no direct reports, however, will informally lead teams in a matrix environment.

QUALIFICATIONS:

Education Level: Bachelor's Degree in Project Management, Business, Public Health, Healthcare Administration, or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 3 years' experience in healthcare quality related field.

Preferred Qualifications:
Project Management Professional Certification (PMP).

Knowledge, Skills and Abilities (KSAs)

• Knowledge of all regulatory guidelines on CMS Star Rating methodologies.
• Skilled in successfully planning and leading presentations to internal and external stakeholders, and C-suite with a focus on all CMS Star Rating domains (CAHPS/Customer Experience, HEDIS, Pharmacy, Operational Excellence).
• Experience in Stars data-management-related analytics, processes and teams.
• Ability to work in a fast-paced environment and drive consistent actions across a matrixed environment.
• Ability to establish working relationships and influence/persuade across all levels of leadership including C-suite.
• Ability to identify and shepherd strategic opportunities that have a significant impact on the organization.
• Use of Microsoft Office applications.

Salary Range: $65,160 - $129,415

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Accreditation & Medical Program

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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