Stars Provider Engagement Lead
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.
For Internal Use Only*
Pay Grade Levels 29-30
Purpose of the Job
This role will collaborate with Stars, Provider Network and MA Leadership Team to lead Stars value based contracting activities to improve Star Rating performance. In this role, provider models will be analyzed and developed for optimal provider performance impacting Stars across all measures. Position will serve as an internal consultant for activities supporting the STAR Ratings including HEDIS, Pharmacy, CAHPS and HOS. Position will also provide strategic vision towards best practices for Stars incentive models, performance scorecards and continued performance improvement tactics. The Stars Gap Closure lead will employ strong analytic, consultative and communication skills to develop and execute strategies related projects and programs (internal and vendor-driven) that optimize performance across our provider networks serving Medicare markets.
Essential Job Functions & Responsibilities
* Partner with the Stars, Provider Network and Medicare Advantage teams to utilize performance analysis methods to identify and recommend provider contracting opportunities for performance improvement
* Actively participate in the development of the strategic plan for Stars and Provider Network
* Monitor and evaluate progress against timelines, project milestones and key deliverables for HEDIS, Pharmacy, CAHPS, HOS improvement activities
* Develop models to incentive and measure HEDIS, Pharmacy and HOS provider improvement activities.
* Develop progressive models to incentivize and measure CAHPS provider improvement activities. Includes the development of CAHPS off-cycle survey feedback for measurement
* Develop and maintain vendor scorecards to ensure direct communication with vendors on improvement opportunities
* Participate in the contract negotiation phase
* Work with Stars Leadership on CAHPS and Health Outcomes Surveys vendor-strategy and subsequent vendor contracts
* Identify opportunities for improvement within vendor contracting structure. Leads discussions on vendor strategy best practices within Quality space
* Strategize with VBCs on their internal quality initiatives to ensure all outreach and gap closure activities include HEDIS gap closure compliance (coding). VBC initiatives must be coordinated to ensure no member abrasion and compliance needs are met.
* Medical record capture/review throughout the year to boost admin rates & reduce hybrid samples
* Coordinate co-branding efforts across VBC lead initiatives
* Manage VBC monthly and quarterly updates including materials development, rate insights, strategic discussions
Reporting and Presentation
* Collaborate across business divisions with various departments such as Operations, Actuarial and Finance to coordinate the development of centralized dashboards/models to identify and track Quality Star progress.
* Use technical skill set to centralize reporting package and project plans for Quality STAR annual projects
* The 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.
Required Work Experience
* 3 years in a progressively responsible leadership consulting or project management role in a complex operational vertical supporting health care and vendor-based programs.
* 3 years’ experience supporting Quality/STAR programs (HEDIS CAHPS, HOS for Medicare Advantage, Medicaid or State-Run Healthcare Programs.
* Bachelor of Art or Bachelor of Science
Preferred Work Experience
* 3 years’ experience with provider engagement or performance programs
4. Preferred Certifications
Required Job Skills
* Advanced knowledge of Medicare, NCQA. CMS Star standards
* Previous experience working in strategy development and implementation, analytical and Quality-based process improvement in the health care health insurance sector or management analytics.
o Microsoft Access, Microsoft Excel, Microsoft PowerPoint (Advanced)
* Excellent writing skills with the ability to compose and deliver a variety of business correspondence
* Excellent verbal skills including ability to present to a variant of audiences
Required Professional Competencies
* Ability to hold providers accountable for program performance
* Demonstrated analytical and critical thinking skills
* Demonstrated interpersonal/verbal communication skills
* Demonstrated written communication skills
* Ability to work in a matrixed environment
* Ability to work as part of a team
* Ability to manage a project-based portfolio with constant deliverables
* Adept at partnership and collaboration both internally and externally
Required Leadership Experience and Competencies
* Strong leadership skills with proven ability to lead change to accommodate evolving organizational and regulatory processes.
1. Preferred Job Skills
2. Preferred Professional Competencies
3. Preferred Leadership Experience and Competencies
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.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross® BlueShield® of Arizona