Blue Shield of California Group
Senior Director, Quality (Medicare Stars) - Strategic
Blue Shield of California Group, Los Angeles, California, United States, 90079
Your RoleReporting to the Vice President, Medicare, this national role of the Sr. Director, Quality (Medicare Stars) will lead and manage the strategic direction, development and execution of quality improvement programs for Medicare health plans. This role is crucial in ensuring that a health plan meets or exceeds regulatory standards, such as those set by the Centers for Medicare & Medicaid Services (CMS) and achieves high ratings in Medicare’s Star rating system. In this role, strategic vision, data-driven decision-making, and strong knowledge of Medicare quality standards and regulations are essential for success.Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
ResponsibilitiesYour WorkIn this role, you will:Quality (Medicare Stars) Program Management: Lead the development of annual and long-term Medicare STARs strategy; Oversee Medicare Stars performance management, including defining metrics at the business unit level; Ensure that programs meet CMS requirements and contribute to high-quality ratings (such as Medicare Star Ratings)Data and Analytics and Reporting: Monitor and analyze performance metrics, including Star ratings, related to Medicare quality metricsCollaboration Across Departments: Coordinate cross-functionally with LOB leaders, Provider Performance and Operations to align on Medicare Stars strategy and drive performance; Facilitate collaboration between teams to ensure an integrated approach to improving quality across the Medicare plans and advise business units in the development of Medicare Stars initiativesRegulatory Compliance: Ensure Medicare programs meet CMS guidelines and adapt to regulatory changesLeadership and Team Management: Build a high-performing team that meets all operating goals, including quality improvement, regulatory compliance, lowering administrative costs and increasing employee engagement; Lead quality teams, providing training and guidance on Medicare standardsImprove Medicare Star Ratings: Instill a culture of continuous quality improvement and innovation. Focus on initiatives that improve the Medicare Star RatingsVendor Management: Oversee third-party vendors or partners involved in the execution of quality initiatives or data reporting
QualificationsYour Knowledge and ExperienceTypically requires a college degree or equivalent experience, and a minimum of 10 years prior relevant experience including 8 years of management experience5+ years of healthcare experience leading larger cross functional programs requiredExpert knowledge of Medicare Stars requiredPrevious experience leading quality and performance improvement for a health plan requiredHighly motivated individual with the ability to work independently in a fast-paced environment with changing prioritiesAbility to interact with all levels of leadership, influence change and lead cross-functional teams and initiativesPay Range:The pay range for this role is: $188,540.00 to $282,810.00 for California.Note:Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
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ResponsibilitiesYour WorkIn this role, you will:Quality (Medicare Stars) Program Management: Lead the development of annual and long-term Medicare STARs strategy; Oversee Medicare Stars performance management, including defining metrics at the business unit level; Ensure that programs meet CMS requirements and contribute to high-quality ratings (such as Medicare Star Ratings)Data and Analytics and Reporting: Monitor and analyze performance metrics, including Star ratings, related to Medicare quality metricsCollaboration Across Departments: Coordinate cross-functionally with LOB leaders, Provider Performance and Operations to align on Medicare Stars strategy and drive performance; Facilitate collaboration between teams to ensure an integrated approach to improving quality across the Medicare plans and advise business units in the development of Medicare Stars initiativesRegulatory Compliance: Ensure Medicare programs meet CMS guidelines and adapt to regulatory changesLeadership and Team Management: Build a high-performing team that meets all operating goals, including quality improvement, regulatory compliance, lowering administrative costs and increasing employee engagement; Lead quality teams, providing training and guidance on Medicare standardsImprove Medicare Star Ratings: Instill a culture of continuous quality improvement and innovation. Focus on initiatives that improve the Medicare Star RatingsVendor Management: Oversee third-party vendors or partners involved in the execution of quality initiatives or data reporting
QualificationsYour Knowledge and ExperienceTypically requires a college degree or equivalent experience, and a minimum of 10 years prior relevant experience including 8 years of management experience5+ years of healthcare experience leading larger cross functional programs requiredExpert knowledge of Medicare Stars requiredPrevious experience leading quality and performance improvement for a health plan requiredHighly motivated individual with the ability to work independently in a fast-paced environment with changing prioritiesAbility to interact with all levels of leadership, influence change and lead cross-functional teams and initiativesPay Range:The pay range for this role is: $188,540.00 to $282,810.00 for California.Note:Please note that this range represents the pay range for this and many other positions at Blue Shield that fall into this pay grade. Blue Shield salaries are based on a variety of factors, including the candidate's experience, location (California, Bay area, or outside California), and current employee salaries for similar roles.
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