Providence Health Plan Group
Quality Program Manager - Health Plan Medicare Advantage Stars *Remote*
Providence Health Plan Group, Washington, District of Columbia, us, 20022
Overview
Quality Program Manager – Health Plan Medicare Advantage Stars is a subject matter expert who uses Stars data, CMS Star Rating Technical Notes, and HPMS memos to develop and implement interventions that improve Star ratings. This role is remote and supports Providence health plan operations. 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 opportunities; use data to develop action and monitoring plans. Collaborate with health plan departments (care management, customer service, outreach, product, sales, marketing, etc.) to develop and implement Star initiatives that improve ratings. Ensure compliance with CMS Star deliverables (plan previews, final HEDIS, CAHPS, HOS results) and stay current with changes affecting Star Ratings (e.g., measure changes, weights, cut points). Monitor and report on Stars program performance, delivering insights and impact to workgroups, committees, and executives. Develop and manage relationships with external partners, stakeholders, and vendors involved in Stars initiatives. Demonstrate strong project management skills, organizing, facilitating, and managing multiple projects and programs simultaneously. Fully understand health plan operations and levers that result in Medicare Advantage Stars improvement; health plan Stars experience and understanding are critical for this role. Location
Providence welcomes virtual work for applicants who reside in Washington or Oregon. 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 or more years of related experience in a managed care organization or clinical setting within a managed care environment 3 or more 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 or more 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, and 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 Stars Salary Range by Location
Oregon: Non-Portland Service Area: Min: $42.08, Max: $65.32 Oregon: Portland Service Area: Min: $45.14, Max: $70.07 Washington: Western - Except Tukwila: Min: $47.05, Max: $73.04 Washington: Southwest - Olympia, Centralia: Min: $45.14, Max: $70.07 Washington: Clark County: Min: $45.14, Max: $70.07 Washington: Eastern: Min: $40.16, Max: $62.35 Washington: Southeastern: Min: $42.08, Max: $65.32 Why Join Providence?
Our best-in-class benefits are designed to support you and your family in staying well, growing professionally, and achieving financial security. We focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence
Providence is a family of organizations dedicated to supporting our Mission and fostering an inclusive workplace where diversity is valued. We serve across multiple states with over 120,000 caregivers in hospitals, clinics, and a full range of health and social services. We are guided by a long-standing tradition of serving the poor and vulnerable. The base pay range is provided; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, and bonus opportunities. Providence offers a comprehensive benefits package including retirement (401(k) with employer matching), health care benefits, life and disability insurance, paid time off, voluntary benefits, well-being resources, and more. Learn more at Providence benefits information. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered in accordance with applicable fair chance ordinances and acts. About the Team
Providence Shared Services provides functional and system support services across the Providence family. We are focused on supporting our Mission by delivering a robust foundation of services and sharing specialized expertise. Providence is an Equal Opportunity Employer. We are committed to a diverse and inclusive workforce with equal opportunities for advancement.
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Quality Program Manager – Health Plan Medicare Advantage Stars is a subject matter expert who uses Stars data, CMS Star Rating Technical Notes, and HPMS memos to develop and implement interventions that improve Star ratings. This role is remote and supports Providence health plan operations. 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 opportunities; use data to develop action and monitoring plans. Collaborate with health plan departments (care management, customer service, outreach, product, sales, marketing, etc.) to develop and implement Star initiatives that improve ratings. Ensure compliance with CMS Star deliverables (plan previews, final HEDIS, CAHPS, HOS results) and stay current with changes affecting Star Ratings (e.g., measure changes, weights, cut points). Monitor and report on Stars program performance, delivering insights and impact to workgroups, committees, and executives. Develop and manage relationships with external partners, stakeholders, and vendors involved in Stars initiatives. Demonstrate strong project management skills, organizing, facilitating, and managing multiple projects and programs simultaneously. Fully understand health plan operations and levers that result in Medicare Advantage Stars improvement; health plan Stars experience and understanding are critical for this role. Location
Providence welcomes virtual work for applicants who reside in Washington or Oregon. 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 or more years of related experience in a managed care organization or clinical setting within a managed care environment 3 or more 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 or more 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, and 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 Stars Salary Range by Location
Oregon: Non-Portland Service Area: Min: $42.08, Max: $65.32 Oregon: Portland Service Area: Min: $45.14, Max: $70.07 Washington: Western - Except Tukwila: Min: $47.05, Max: $73.04 Washington: Southwest - Olympia, Centralia: Min: $45.14, Max: $70.07 Washington: Clark County: Min: $45.14, Max: $70.07 Washington: Eastern: Min: $40.16, Max: $62.35 Washington: Southeastern: Min: $42.08, Max: $65.32 Why Join Providence?
Our best-in-class benefits are designed to support you and your family in staying well, growing professionally, and achieving financial security. We focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities. About Providence
Providence is a family of organizations dedicated to supporting our Mission and fostering an inclusive workplace where diversity is valued. We serve across multiple states with over 120,000 caregivers in hospitals, clinics, and a full range of health and social services. We are guided by a long-standing tradition of serving the poor and vulnerable. The base pay range is provided; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, and bonus opportunities. Providence offers a comprehensive benefits package including retirement (401(k) with employer matching), health care benefits, life and disability insurance, paid time off, voluntary benefits, well-being resources, and more. Learn more at Providence benefits information. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered in accordance with applicable fair chance ordinances and acts. About the Team
Providence Shared Services provides functional and system support services across the Providence family. We are focused on supporting our Mission by delivering a robust foundation of services and sharing specialized expertise. Providence is an Equal Opportunity Employer. We are committed to a diverse and inclusive workforce with equal opportunities for advancement.
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