Medicare STAR Program Manager

Job Summary The Quality Department is committed to preventing disease, ensuring patient safety, and eliminating inequities by improving the quality of care received by members through partnerships with providers and community-based organizations. The Medicare STARS Program Manager is responsible for informing, promoting, and leading the evolution of CenCal Health’s managed care systems to maximize quality as measured by the Centers for Medicare and Medicaid Services (CMS) 5 STAR Rating System. Reporting to the Executive Quality and Population Health Officer, the Medicare STARS Program Manager plays a pivotal role to strategically optimize operational initiatives plan wide to maximize CenCal Health’s Duals Special Needs Plan (D-SNP) STAR ratings, and to elevate CenCal Health’s Medicare STAR Rating Program governance. The successful D-SNP STAR Program Manager is a subject matter expert (SME) in regulations that govern the CMS Medicare D-SNP STAR Rating System, and in the application of operational strategies and tactics to maximize Star Rating System outcomes. The Medicare STARS Program Manager will serve as a high-level individual contributor. Duties and Responsibilities: Sustained up-to-date D-SNP STARS System subject matter expertise of significant complexity, understanding of the present and future operational impacts of changes to STAR Rating Program requirements. Ability to clearly communicate STAR Rating System requirements and their impacts to operational systems enterprise-wide; collaboration with cross-functional teams to build an understanding of the intersection between STAR Rating requirements and the operational excellence required to achieve exceptional member experience and outcomes. Subject Matter Expertise liaison to stakeholders’ enterprise-wide to provide strategic guidance to support and promote process deployment, refinement, and execution to maximize STAR ratings. Collaborate with cross-functional teams to drive systems improvement to maximize STAR measure ratings, with duties including but not limited to: At least annually develop CenCal Health’s STAR Rating Program strategic objectives as a component of CenCal Health’s Quality Improvement and Health Equity Transformation Program (QIHETP) Work Plan, and in congruence with CenCal Health’s Population Health Management Strategy, and Operating Plan. Update STAR Rating Program strategic objectives quarterly in congruence with emerging requirements and priorities. Optimize use of vendor STARS applications, and design and implement solutions in collaboration with cross-functional stakeholders and the Information Technology Division, to monitor performance relative to CenCal Health’s STAR Rating Program goals and enable effective STAR Rating Program governance. Cultivate and sustain mutually beneficial partnerships with CenCal Health’s vendors that provide systems to monitor and manage STARS performance. Monitor, track, and communicate STARS-related Key Performance Indicator outcomes, to demonstrate and elevate the effectiveness of CenCal Health’s STAR Rating Program. Oversee the preparation and filing of the measures included in the CMS STAR Rating Program and maintain reports and back up information to review preliminary measure results to ensure the accuracy of the STAR Rating Program information. Serve as a SME and resource enterprise-wide, providing strategic guidance to CenCal Health Senior Leadership Team and stakeholders, with duties including but not limited to: Collaborating with CenCal Health’s teams, including but not limited to Population Health Management, Medical Management, Member Services, and Quality, to promote the evolution of operational systems aligned with STAR Rating Program goals and CMS requirements. Stay informed and up to date about prospective changes to D-SNP STARS Program measures, reporting requirements and program updates, and communicate requirements to relevant stakeholders to maximize the time to adapt operational systems to changes in D-SNP STARS requirements. Support the development of robust Auditing & Monitoring (A&M) activities to assure complete and accurate data sources and processes necessary to generate reliable source data that complies with CMS D-SNP STARS measure specifications. Promote alignment of organizational processes and strategies with D-SNP STAR Rating Program requirements, and the execution of strategies and tactics to maximize CenCal Health’s STAR ratings. Assure readiness for CMS D-SNP STARS audits, and coordinate, facilitate and ensure timely response to audit findings, including timely development, implementation, and closure of corrective action plans (excludes annual NCQA HEDIS Compliance Audit) . Contribute expertise and STARS Program performance insights to multidisciplinary teams to collaboratively plan, deploy, and execute strategies and processes to continuously monitor, achieve, and sustain 5-star ratings. Develop and facilitate training to CenCal Health staff to maximize CenCal Health D-SNP STARS Program readiness. Education and Experience Required: Bachelor's degree in Healthcare Administration, Public Health, Nursing, or a related field. Three years of experience with a Medicare STAR Rating Program, including thorough understanding of STARS Program data submission requirements. Four years of experience in a Medicare managed care organization. Three years of experience managing audit relations with regulatory or accrediting bodies (e.g., CMS, NCQA). Must be proficient in creating and preparing reports and presentations.