Jobs for People with MS: National MS Society

PRINCIPLE RESPONSIBILITIES:

Under the general direction of the Executive Director, Medicare Programs, the Director, Stars Strategy and Program Management will be responsible for the planning, development, implementation, and strategic oversight of Medicare Stars to meet the corporate goal of achieving a 4+ Stars rating for the Alliances Medicare Advantage Dual Special Needs Plan (D-SNP) product. This position is responsible for planning, developing, and directing the implementation of strategies to ensure high levels of performance and quality in the Medicare Stars and risk adjustment activities. The incumbent will be responsible for overall Stars coordination, including planning and sequencing work, setting milestones and deadlines, assigning responsibilities, facilitating cross-functional workgroups, monitoring progress, and reporting Stars domain statuses.

The Director is responsible for establishing a comprehensive strategy to support the Stars and risk adjustment program for the Medicare line of business to ensure accurate and consistent reporting to government agencies and to reflect members accurate disease burden.

Working closely with senior and departmental leadership, the Director will ensure the effective performance and compliance with State and Federal regulatory requirements for all Medicare Stars and risk adjustment functions across the Alliance. The position will work with the Executive Director, Medicare Programs, and cross functional leadership to develop and implement short-term and long-range objectives consistent with Alameda Alliance for Health goals and guidelines.

Principle responsibilities include:

• Providing strategic management oversight in developing, implementing, directing, and monitoring the Alliances Medicare Stars Program, including strategy development and domain design, as well as ensuring effective ongoing operational program management.

• Leading the Stars design of the Alliances first Medicare D-SNP program model, developing and identifying strategies and tactics to establish and increase the Medicare Stars rating.

• Collaborating with Plan leaders to identify and close initial operational and analytical gaps to ensure a successful D-SNP go-to-market launch and performing ongoing assessments to ensure successful operational program management.

• Assessing internal capacity, capability, cost/benefit, and making recommendations on what functions the Alliance operates or outsources, related to the Medicare Stars Program.

• Designing, implementing, and managing a portfolio of Medicare Stars interventions that meet the needs of customers and stakeholders on an ongoing basis.

• Understanding the needs of current and prospective members through market research and analysis, including focus groups, industry satisfaction surveys, and incorporating member voice.

• Developing and managing the Alliances Medicare risk adjustment program

• Utilizing matrix management and holding cross-functional accountability for the operational management of the Medicare Stars Program and ensuring that all required functions listed below have effective operationalized D-SNP processes and ability to advise as a Subject Matter Expert:

• • Claims Processing
  • Member Services
  • Case Management/Care Coordination
  • Quality Improvement
  • Provider Services (includes Network Development and Contracting)
  • Appeals and Grievance
  • Analytics

• Directs the Medicare Stars Program, acts as a subject matter expert, and provides education and guidance on Medicare Stars issues and overall business operations, with duties including but not limited to:

• • Lead and champion governance of a cross-functional Medicare Stars operating model, assigning responsibility accountabilities for Stars performance across all measures, and convening a Steering Committee to guide strategy and break down organizational barriers to success.
  • Lead efforts to increase and maximize the Medicare Stars ratings by developing short and long-term strategies, including goals and objectives (with measurable outcomes) across applicable departments.
  • Provide management with overall status reports related to month-over-month and year-over-year Stars performance, including any risks or issues that may impact the organizations ability to achieve 4 Stars.
  • Develop and implement a member experience, risk adjustment, HEDIS, and quality navigator/practice advisor framework to embed into all Medicare-related workstreams.
  • Collaborate with senior and departmental leadership to design, implement, evaluate, and refine policies and Standard Operating Procedures (SOPs) promoting accurate coding practices and Stars program management.
  • Partner with analytical teams to determine measure-level targets for every Stars measure and develop a monitoring dashboard to create visibility of performance, risks, and opportunities in Stars measure performance.
  • Develop and implement framework for Stars vendor management, developing a rubric for standards and performance management for various vended interventions.
  • Performance monitoring and generating new standards and processes to improve Stars ratings, Consumer Assessment of Healthcare Providers and Systems (CAHPS), and Health Outcomes Survey (HOS)

• Demonstrate strong strategic leadership and change management skills.

• Set clear goals and objectives and give feedback on development needs.

• Hold managers accountable for results, including staff development.

• Successfully execute short term and long-term plans, capacity modeling, and real-time staff utilization as well as consistently meet pre-defined service objectives.

• Maintain consistent regulatory compliance with teams through appropriate communication, training, and performance management.

• Handle multiple Stars domains simultaneously and ensure coordination with various departments.

• Establish appropriate, well-defined Stars performance competencies and metrics.

• Ensure competencies and metrics are communicated, understood, and met or exceeded by all departmental staff.

• Establish and maintain effective working relationships with staff at all levels within the organization.

• Communicate clearly and concisely, both verbally and in writing.

• Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint, Visio) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position as required.

• Supervisory responsibilities to direct-reports and matrix-reporting, clearly defining goals and objectives, and periodically meeting with staff and teams to maintain communication channels.

• Communicates effectively and efficiently to internal staff and external entities.

• Facilitates internal and external committees and meetings.

• Complies with the organizations Code of Conduct, all regulatory and contractual requirements, organizational policies, procedures, and internal controls.

PHYSICAL REQUIREMENTS:

• Constant and close visual work at a desk or a computer.
• Constant sitting and working at a desk.
• Constant data entry using a keyboard and/or mouse.
• Frequent use of a telephone headset.
• Constant verbal and written communication with staff and other business associates by telephone, correspondence, or in person.
• Frequent lifting of folders and other objects weighing between 0 and 30 lbs.
• Frequent walking and standing.
• Occasional driving of automobiles.

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