Providence Health & Services
Quality Program Manager - Health Plan Medicare Advantage Stars *Remote*
Providence Health & Services, Washington, District of Columbia, us, 20022
Overview
Quality Program Manager - Health Plan Medicare Advantage Stars
– Remote Role overview: The Quality Program Manager – Health Plan Medicare Advantage Stars is a health plan Star Ratings Subject Matter Expert (SME) who uses Stars data, CMS Star Rating Technical Notes, and HPMS memos to develop and implement best-practice interventions that improve Star ratings. Responsibilities
Develop and implement best-practice interventions to improve Medicare Advantage Star Ratings, driving clinical quality indicators (HEDIS Star metrics), CAHPS, and HOS efforts. Utilize reports and dashboards to identify Star rating trends, gaps, and areas for improvement, and use data to develop action and monitoring plans. Collaborate with health plan departments (care management, customer service, outreach, product, sales, marketing, etc.) to implement Stars initiatives that improve ratings. Ensure compliance with CMS Stars deliverables (plan previews, final HEDIS, CAHPS, HOS results) and stay updated on changes affecting Star Ratings (measure changes, weights, cut points). Monitor and report on Stars program performance, delivering insights and interventions to workgroups, committees, and executives. Develop and manage relationships with external partners, stakeholders, and vendors involved in Stars initiatives. Demonstrate strong project management skills, capable of organizing, facilitating, and managing multiple projects and programs simultaneously. Fully understand health plan operations and levers that drive Medicare Advantage Stars improvement; health plan Stars experience and understanding are critical in this role. Qualifications
Required Qualifications
Bachelor's Degree - OR - Master's Degree in Public Health, Business Administration, Health Science, Health Services Administration, or related field - OR - a combination of equivalent education and work experience 3+ years of related experience in a managed care organization or clinical setting in a managed care environment 3+ years of experience in project management or program management Demonstrated experience in program planning, development, and evaluation Preferred Qualifications
Experience in quality management principles, tools, and techniques 5+ years of experience in project management or program management Experience with Stars program oversight, including intervention development and implementation for clinical quality (Stars HEDIS) measures, CAHPS, HOS Deep understanding of the Medicare Advantage Stars program, CMS Star Rating Technical Notes, HPMS memos, and ability to interpret and act on CMS guidance specific to the Stars program Location & Salary
Providence welcomes virtual work for applicants in Washington or Oregon Salary ranges by location (illustrative): Oregon: Non-Portland Service Area Min $42.08 – Max $65.32; Oregon: Portland Service Area Min $45.14 – Max $70.07; Washington (various regions) ranges provided in posting About Providence
Providence is a family of organizations committed to the Mission of caring for everyone, especially the vulnerable. We offer comprehensive benefits and a diverse, inclusive workplace across multiple states. The base pay range is posted with possible additional compensation such as shift differentials, standby/on-call, overtime, premiums, or bonus opportunities. Equal Employment Opportunity
Providence is proud to be an Equal Opportunity Employer. We are committed to non-discrimination and equal opportunities for advancement for all workforce members. Requisition & Contact
Requisition ID:
389052 Company:
Providence Jobs Job Category:
Clinical Quality Job Function:
Quality/Process Improvements Job Schedule:
Full time Job Shift:
Day Work Location:
Remote
#J-18808-Ljbffr
Quality Program Manager - Health Plan Medicare Advantage Stars
– Remote Role overview: The Quality Program Manager – Health Plan Medicare Advantage Stars is a health plan Star Ratings Subject Matter Expert (SME) who uses Stars data, CMS Star Rating Technical Notes, and HPMS memos to develop and implement best-practice interventions that improve Star ratings. Responsibilities
Develop and implement best-practice interventions to improve Medicare Advantage Star Ratings, driving clinical quality indicators (HEDIS Star metrics), CAHPS, and HOS efforts. Utilize reports and dashboards to identify Star rating trends, gaps, and areas for improvement, and use data to develop action and monitoring plans. Collaborate with health plan departments (care management, customer service, outreach, product, sales, marketing, etc.) to implement Stars initiatives that improve ratings. Ensure compliance with CMS Stars deliverables (plan previews, final HEDIS, CAHPS, HOS results) and stay updated on changes affecting Star Ratings (measure changes, weights, cut points). Monitor and report on Stars program performance, delivering insights and interventions to workgroups, committees, and executives. Develop and manage relationships with external partners, stakeholders, and vendors involved in Stars initiatives. Demonstrate strong project management skills, capable of organizing, facilitating, and managing multiple projects and programs simultaneously. Fully understand health plan operations and levers that drive Medicare Advantage Stars improvement; health plan Stars experience and understanding are critical in this role. Qualifications
Required Qualifications
Bachelor's Degree - OR - Master's Degree in Public Health, Business Administration, Health Science, Health Services Administration, or related field - OR - a combination of equivalent education and work experience 3+ years of related experience in a managed care organization or clinical setting in a managed care environment 3+ years of experience in project management or program management Demonstrated experience in program planning, development, and evaluation Preferred Qualifications
Experience in quality management principles, tools, and techniques 5+ years of experience in project management or program management Experience with Stars program oversight, including intervention development and implementation for clinical quality (Stars HEDIS) measures, CAHPS, HOS Deep understanding of the Medicare Advantage Stars program, CMS Star Rating Technical Notes, HPMS memos, and ability to interpret and act on CMS guidance specific to the Stars program Location & Salary
Providence welcomes virtual work for applicants in Washington or Oregon Salary ranges by location (illustrative): Oregon: Non-Portland Service Area Min $42.08 – Max $65.32; Oregon: Portland Service Area Min $45.14 – Max $70.07; Washington (various regions) ranges provided in posting About Providence
Providence is a family of organizations committed to the Mission of caring for everyone, especially the vulnerable. We offer comprehensive benefits and a diverse, inclusive workplace across multiple states. The base pay range is posted with possible additional compensation such as shift differentials, standby/on-call, overtime, premiums, or bonus opportunities. Equal Employment Opportunity
Providence is proud to be an Equal Opportunity Employer. We are committed to non-discrimination and equal opportunities for advancement for all workforce members. Requisition & Contact
Requisition ID:
389052 Company:
Providence Jobs Job Category:
Clinical Quality Job Function:
Quality/Process Improvements Job Schedule:
Full time Job Shift:
Day Work Location:
Remote
#J-18808-Ljbffr