Medicare Stars Manager

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Job description

As a Consulting Manager at ProspHire you will be a Firm leader, client delivery expert and mentor to junior staff. At a fast growing, 60+ person management consulting firm, this means you'll use your problem-solving and resource management skills to manage growth and profitability of growing health plan accounts. You'll cultivate and build relationships at all levels of a client organization to earn "trusted advisor" status while also serving as a mentor. You'll get in the trenches and stand shoulder-to-shoulder with our health plan clients to solve their people, process and technology challenges.

The ideal candidate will have a strong background in HEDIS/Stars and experience leading a quality improvement program in accordance with the strategic goals of a health plan.

Requirements

Engage executive leadership on HEDIS/Stars strategy, make recommendations to address areas of concern and provide status on projected results

Collaborate with health plan leadership to develop processes to measure and collect data for HEDIS/Stars indicators

Implement a quality improvement program in accordance with the strategic goals of a health plan; Analyze and identify trends to develop improvement strategies and action plans for quality rating systems (HEDIS, QRS, Stars) across all lines of business

Manage quality initiatives and work cross-functionally with clinical and technical teams to develop the tools, processes and reporting required to ensure compliance with a complete and accurate coding and billing function

Provide timely monitoring of HEDIS/Stars program data submissions: CAHPS, HOS, HEDIS, etc.

Establish and communicate protocols and standards of care for the Medicare Advantage, Medicaid and ACA member populations while providing intervention guidelines based on current population health needs

Establish professional relationships with vendor partners, regulators, internal stakeholders and community agencies to facilitate quality processes

Closely follow CMS guidelines and translate into business strategies and tactics

Plan and lead client engagements; Facilitate buy-in of proposed solutions from clients; Define timing, manage resources and direct on-time, quality production of deliverables

Summarize and deliver information to clients through highly polished documentation and presentations; Communicate status, issues and risks to leadership

Develop and maintain relationships with key client decision makers; Lead, articulate and negotiate business cases for Firm's service offerings; Consistently meet and exceed sales and managed revenue requirements

Appropriately forecast and manage engagement risk, budget and resources with the Firm and client

Mentor and coach junior team members, conduct performance reviews and support the Firm's overall recruitment and retention efforts

Serve as a member of the Firm's Leadership Team; Represent the Firm positively by building and maintaining strong relationships with professionals and team members at all levels

Qualifications:

A bachelor's degree in a relevant field required; Master's degree in healthcare or MBA preferred

Deep understanding of Medicare, Stars and HEDIS programs

Experience managing programs and interventions through a full Stars cycle

8+ years' professional experience in Health Plans, Payers or Government Programs, or a mix of a few years' industry experience combined with consulting at the manager level

PMP or Six Sigma Black Belt certification preferred

Consulting experience preferred

Authorization to work in the U.S.

Ability to travel up to 50% of the time, if necessary; Our Firm has national clients

Benefits

Competitive compensation, plus bonus

Medical, vision and dental

401k with 4% match

Flexible time off and paid holidays

Paid parental leave

$500 annual wellness subsidy

Modern and cool workspace in Downtown Pittsburgh

Snacks (of course)

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