National Sr. Quality Director, Medicare

United States Minor Outlying Islands

Remote position available

Job Description

The Sr Director of Quality, Medicare is responsible for all aspects of the quality program for developing the Medicare STAR strategy, short and long-term STARS initiatives and oversight of STARS performance. He/she will implement and maintain the enterprise STAR quality improvement program in alignment with the Quality Roadmap, Health Care Quality Index and the Health Plans to achieve desired outcomes for members.

Essential Functions

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  • Directs and leads Medicare quality staff to meet goals for STARS performance, including opportunity identification, program design, impact analysis and program evaluation 
  • Develops and executes workplan for STARS strategy, initiatives and performance 
  • Identifies opportunities for STARS program and measures improvement 
  • Manages team: hiring and training, performance and salary reviews, promotions and disciplinary matters for direct reporting employees 
  • Supports all related Medicare STAR compliance and reporting as specified by CMS and in alignment with the Medicare Compliance officer  
  • Provides leadership and direction in the implementation of initiatives to ensure programs accomplish objectives in a timely and successful manner 
  • Drives year-round chart chases 
  • Responsible for operations and compliance including regulatory/operational trends, markets, competitors, financing, regulation, and risk adjustment 
  • Leads Medicare staff through Medicare Part C and D CMS Audits 
  • Works collaboratively to support the provider and member incentive work with providers and medical groups 
  • Supports the Medicare Medical Director on specific vendor programs necessary to deliver improved medical group STAR performance and Risk scores   
  • Meets regularly to ensure alignment of the STAR team work with Medicare MD targeted initiatives   
  • Monitors changes in regulatory environment governing payer quality bonus system (Medicare STARS), have strong understanding of CMS changes and the regulatory landscape and understand ongoing changes in scoring and quality metrics  
  • Monitors market demand that results from quality bonus system   
  • Maintains a robust methodology to project and track STAR performance for the organization; including engaging outside experts as needed  
  • Staffs and Chairs the Medicare STARS Quarterly Steering Committee and reports plan, monitoring and results to the Governance Committee and is part of the Centers for Excellence 
  • Advises Executive leadership on new STARS initiatives   
  • Drives corporate awareness, culture changes, and training for STARS  
  • Drives process changes across the enterprise to improve performance in CAHPS, Net Promoter Score (NPS) and other vital measures that will maximize rating 
  • Understands federal and state regulatory environment, up to date with every changing regulation and integrate rules into enterprise strategies 

General Job Information

Title

National Sr. Quality Director, Medicare

Grade

31

Job Family

Quality Group

Country

United States of America

FLSA Status

United States of America (Exempt)

Recruiting Start Date

5/13/2019

Date Requisition Created

5/10/2019

Minimum Qualifications

Education

Bachelors: Nursing (Required), Bachelors: Public Health (Required)

License and Certifications - Required

License and Certifications - Preferred

Other Job Requirements

Responsibilities

Preferred Qualifications

  • Master’s degree in relevant field e.g. MHA, MBA, MPH or similar is preferred 
  • Demonstrated experience in leading significant cross-functional work 
  • Conceptual and in-depth knowledge of the healthcare industry within a health plan 
  • Ability to lead direct and indirect operational teams to achieve business performance and deliver CMS requirements in an effective and efficient manner 
  • Ability to manage relationships with an emphasis on internal and external mid-level relationships 
  • Ability to work across all levels of the organization, including work with the executive audiences, vendors and the government as a customer 
  • Demonstrated ability to select and implement strategies that are most likely to be successful 

Required Qualifications

  • Ten plus years of experience with quality improvement, strategy design, management implementation and known improvement in Health Plan STAR rating and maintenance of 4 STARS and above 
  • Ten plus years of demonstrated leadership and team development skills, including the specific people management capabilities of on-boarding, coaching and performance management 
  • Bachelor’s degree in Nursing, Public Health or another related field required 
  • Knowledge of the Medicare STARS payment system, MA, HEDIS, and other clinical quality measurement systems 
  • Experience working with Medicare populations and excellent working knowledge of the STARS program 
  • Ability to work effectively in a fast-paced 4 STAR environment 
  • Proficient in Microsoft Office tools 
  • Strong analytical skills, strategic thinking and problem solving 
  • Strong communication skills, both verbally and written 
  • Ability to interact effectively with Business owners, senior management, and peers across the organization 

Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled. Every employee must understand, comply and attest to the security responsibilities and security controls unique to their position.

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