Stars Program Manager - Medicare Advantage
Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.
Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Purpose of the Job
The Stars Program manager will plan, organize, direct and implement programs that support the organizational goal of 4 Star Medicare Advantage plans. This position will support strategy and initiative development across HEDIS, Pharmacy, Operations, CAHPS, HOS and improvement measures. The Stars Program manager will coordinate the Stars Governance Framework across Executive Oversight Committee to Category Lead workgroups. Key activities include optimization of improvement strategies through the identification and execution of initiatives focused on supporting and improving the Stars Program infrastructure, tools, and key performance metrics, resulting in 4-star performance across all contracts. Exceptional skills in developing relevant relationships, promoting positive professional communications, motivating members to improve health, and working with provider partners and vendors on innovative solutions. This position will develop and deliver ongoing education to providers on the Stars Program strategy and performance as well as coordinate discussions with key provider partners on their external programs supporting Star improvement.
Essential Job Functions & Responsibilities
• Serves as a subject matter expert for the Stars Program across all key categories of measures (HEDIS, Pharmacy, Operations, CAHPS, HOS, Improvement). Provider insight and analysis on trends for proactive strategies at entity and provider level
• Leads program regulation and technical specification reviews and comments within required timelines
• Collaboration with provider partners to develop Star roadmap and identify protocols for co-brandings, reporting and member engagement
• Develops and maintains relationships with provider partners to develop short and long term strategies on the advancement of Star measures and interventions for members
• Works with internal and vendor based analytic platforms to identify opportunities for improvement, gap closure and facilitates efforts to implement processes and process change to promote positive advances
• Create and maintain tracking and reporting system that documents key performance metrics and provides mechanism for evaluation of activities coordination and effectiveness related to the Star Program
• Providers comprehensive analysis of Star measures, barriers, and opportunities and present results of improvement efforts and ongoing performance measures to Health Plan leadership
• Creates presentations and/or reports for senior management involving significant analysis of multiple or complex data sources. Chairs Stars Executive Oversight Committee as part of the Stars Governance and acts as coordination point for all other category committees impacting Stars.
• Collaborates with other leaders to research and analyze opportunities for Star improvement across provider and member facing activities
• Coordinates regular project meetings to discuss project status, problems, teamwork, etc. and alerts sponsors to problems or risks that may jeopardize program success. Providers recommendations to mitigate. Escalates when insurmountable barriers exist.
• Position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other duties as assigned
Within BCBSAZ and HCA, it is essential that we create a culture of inclusion and opportunity as well as actively guard against bias of any kind. Discrimination and racism are real. Our aim is to empower every member of our team to engage in our mission of improving health for Arizonans. We believe that the power and perspective of diversity and inclusion is in fact, essential to our success in serving clients, achieving our mission and creating a healthy environment for all.
BCBSAZ does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Skills / Requirements
1. Required Work Experience
• 5 years of healthcare quality or performance improvement experience
• 3 years of experience in CMS Star Ratings Program performance, measurement, analytics, reporting and forecasting
• 3 years of Medicare experience.
2. Required Education
• Bachelor of Art or Bachelor of Science
3. Required Licenses
4. Required Certifications
1. Preferred Work Experience
2. Preferred Education
3. Preferred Licenses
4. Preferred Certifications
1. Required Job Skills
• Advanced knowledge of Medicare, NCQA, CMS Star standards
• Advanced Proficiency with Microsoft office suite applications including:
• Ability to quickly learn and understand CMS regulatory and contractual documents, including corporate policies & procedures
• Excellent analytical and problem-solving skills
• Excellent writing skills with the ability to compose and deliver a variety of business correspondence.
• Excellent verbal skills including ability to present to a variety of audiences.
• Ability to build trusting relationships and maintain confidentiality and privacy.
2. Required Professional Competencies
• Exudes excellence by setting high standards of performance for self and all coworkers, demonstrates low tolerance for mediocrity, requires high-quality results and exhibits conscientiousness and high sense of responsibility.
• Stimulates creativity with the ability to see broadly outside the typical status quo and is constantly open to and promotes new ideas.
• Excellent trouble-shooting, analytic and problem-solving skills with the ability to create and communicate effective solutions.
• Ability to be organized and manage multiple tasks simultaneously in a demanding, fast-paced environment while keeping relevant others in the organization informed of progress and/or obstacles.
• Ability to successfully work with minimal supervision, seeks out and seizes opportunities, finds ways to surmount barriers, and takes lead roles in working with key stakeholders and other analysts.
• Shares important and relevant information with the team. Proactively offers suggestions, provides resources, volunteers for assignments, and removes barriers to help the team accomplish its goals.
• Demonstrate effective interpersonal and active listening skills to achieve customer satisfaction and support departmental communication standards.
3. Required Leadership Experience and Competencies
1. Preferred Job Skills
2. Preferred Professional Competencies
3. Preferred Leadership Experience and Competencies