Job Description

Job Summary

Leads and directs team responsible for Medicare Stars quality improvement (QI) programs and activities. Oversees initiatives and education programs designed to enhance Medicare Star ratings. Responsible for planning, developing and directing the implementation of improvement strategies to ensure high performance across Medicare Stars and quality improvements programs. Ensures maintenance of quality programs for members in accordance with established federal/state and National Committee for Quality Assurance (NCQA) standards. Oversees data collection, reporting and monitoring for key performance measurement activities, and provides direction and implementation of key Medicare Stars strategies to support program improvement and alignment with program regulations.

Essential Job Duties

• Leads Medicare Star program enterprise governance development and ongoing execution across measure level owners.
• Supports Star program strategy development and ongoing execution for continuous program improvement and standardization.
• Collaborates and facilitates Medicare Star program activities with other units at corporate and with state health plans for intervention development and execution to support Medicare Stars measure level improvement and program revenue maximization across all key categories of the Stars program.
• Leads Medicare Stars corporate and health plan engagement strategies and discussions in evaluating high performing activities for expansion opportunities.
• Provides direction for Stars program activities with department leadership including leading corporate Stars initiatives that require timely follow-up, tracking and communication on an ongoing basis.
• Serves as a Stars subject matter expert and leads programs to meet critical Stars performance targets.
• Communicates with and escalates gaps and barriers in implementation and compliance to department leadership, including proposed resolution.
• Monitors and tracks key quality indicators, programs and initiatives to reflect the value and effectiveness of the Stars and quality improvement (QI) programs.
• Hires, trains, mentors, develops and manages performance of team; demonstrates accountability for team performance/achievement of established departmental goals.

Required Qualifications

• At least 8 years of experience in health care, with at least 5 years of experience in health plan quality improvement/compliance/provider improvement/Medicare Stars, or equivalent combination of relevant education and experience.
• At least 3 years management/leadership experience.
• Demonstrated knowledge and experience related to the Medicare Stars program including in-depth knowledge of key Stars categories: Healthcare Effectiveness Data and Information Set (HEDIS), pharmacy, operations, Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Outcomes Survey (HOS), and other quality improvement (QI) measures.
• Deep knowledge of the quality discipline, including metrics and performance standards.
• Advanced knowledge and understanding of HEDIS/NCQA.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Healthcare Effectiveness Data and Information Set (HEDIS) reporting/collection experience.
• Experience with government-sponsored programs (Medicaid, Medicare, Marketplace).
• Experience developing performance measures that support business objectives.
• State quality improvement (QI) experience.
• Solid business writing experience.
• Strong strategic-thinking skills.
• Strong proficiency with data analysis, manipulation, interpretation, reporting and data-driven decision-making.
• Critical-thinking, problem-solving and analytical skills.
• Attention to detail and organizational skills.
• Ability to implement process improvement initiatives and drive change.
• Ability to work independently in a fast-paced, deadline-driven environment.
• Ability to work in a cross-functional highly matrixed organization.
• Project management experience.
• Excellent verbal and written communication skills.
• Microsoft Office suite (including Excel), and applicable software programs proficiency, and ability to learn new information systems and software programs.

Preferred Qualifications

• Deep Medicare Stars improvement regulatory reporting, analytics experience.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) improvement experience.
• Knowledge of Health Outcomes Survey (HOS) and pay for performance (P4P) models.
• Experience in managing provider engagement activities including contract development for quality performance standards.
• Health care information systems experience.
• Experience in a quality leadership role with a managed care payer with experience in all lines of business (Medicaid, Medicare, and/or Marketplace).
• Experience with clinical intervention concepts, design of quality improvement projects (QIPs), advanced QI concepts, identification of target and subset populations, and basic statistical analysis and significance concepts.
• Certified Professional in Health Quality (CPHQ).

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V