Manager, Stars Strategy
Manager II – BPM
Who We Are:
UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members’ well-being. With our commitment to simplicity, honesty, and leadership, we navigate challenges with our customers to achieve affordable health care for all.
We have a strong global presence and a dedicated workforce of over 4000 people spread across the world.
Our brand is built on the strong foundation of simplicity, integrity, people-centricity, and leadership. We stay inspired in our goal to unburden healthcare and ensure it reaches all, equitably and effectively.
You Are:
The role and responsibilities of the Manager- focusing on Quality and Stars Performance is responsible to plan, organize, direct, control, and lead the assigned business unit. This position specializes in running the day-to-day operation for optimizing performance needed to achieve continuous improvement in Stars rating. The role has primary client facing responsibilities and performs within a matrixed, stakeholder partnership environment and should excel in driving synergistic strategies that drive end to end Stars and HEDIS improvement.
The Opportunity:
· To promote our client’s mission of helping people live healthier lives and achieve optimum performance in Stars score.
· Leads client Stars initiative execution activities.
· Leads client performance management team.
· Coordinates critical components of our client’s quality management program in compliance with regulatory requirements and NCQA accreditation standards.
· Manager works within highly matrixed relationships to implement and maintain the core infrastructure of quality management program.
· Oversees the implementation of plan quality management components within the client’s market for affiliates and employed medical groups.
· Proactively manages and responds to rapidly changing CMS requirements and environments.
· Collaborates across business segments to attain or maintain the plan's compliance with CMS, NCQA, PQA standards and contractual requirements as they apply to the quality management program (HEDIS, Part D/Patient Safety, and Patient Experience)
· Develops and maintains positive relationships with internal and external stakeholders who impact Stars & HEDIS performance including but not limited to health plan partners within the scope of the quality management program.
· Commands a comprehensive knowledge of risk arrangements, contracts, member, and provider benefit structure.
· Ensures the creation and submission of reports to meet Client and health plan contractual requirements.
· Identifies gaps in patient care and conveys to our client’s offering recommendations for provider and patient engagement for CMS Star Rating
· Prepares presentation and data for reporting to clients.
· Develops strategies for quality improvement opportunities, including Star Measures and HEDIS gap closure and patient experience.
· Maintains and develops strong collaborative relationships with internal and external stakeholders who impact Stars score performance, client payors, network providers/affiliates, vendors, and internal health data teams are producing accurate and complete reporting clients require to assure improved CMS quality program performance.
· Conducts in-depth analyses to target potential interventions or initiatives to improve health plan members quality of care and experience.
· Tracks and reports KPIs and KAIs to achieve improved CMS Star Rating
· Managers others (performance management, guidance, support, assessments, interviews, training)
This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
What You Need:
· Bachelor's degree in healthcare related field, or comparable experience, master’s degree preferred
· (5) years’ experience in related field with attention to preventative care within government funded health system programs and populations. Three (3+) years supervisory or lead experience in related field required. Bilingual skills preferred.
· 3+ years of experience with demonstrated functional knowledge related to regulatory adherence of a quality management program (HEDIS, Part D/Patient Safety, NCQA, Stars, auditing, reporting, committee management)
· Experience leading Quality teams or similar supervisory experience.
· Experience making formal presentations in front of committees and work group environments and using virtual technology (e.g., Microsoft Teams/Zoom)
· Proficiency in software applications that include, but are not limited to, Microsoft Word, Excel, Outlook, PowerPoint
· Proven solid written and oral communication skills with internal and external partners and employees.
· Effective project management skills in creating, evaluating, and improving strategies for project execution.
· Ability to work under general direction.
Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. UST HealthProof provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.
Role Location: Remote
Compensation Range: $86,900-$126,000
A successful employee in this role may be eligible for incentive payments based on company and individual performance.
Benefits
Full-time, regular employees accrue up to 16 days of paid vacation per year, receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year), 10 paid holidays, and are eligible for paid bereavement leave. They are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance, as well as the following Company-paid benefits: basic life insurance, accidental death and disability insurance, and short- and long-term disability benefits. Regular employees may purchase additional voluntary short-term disability benefits, and participate in a Health Savings Account (HSA) as well as a Flexible Spending Account (FSA) for healthcare, dependent child care, and/or commuting expenses. Certain regular employees may have the potential for quarterly incentive-based bonuses and or commissions depending on role. Benefits offerings vary in Puerto Rico.
Part-time employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) Retirement Plan with employer matching.
Full-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year) and are eligible to participate in the Company’s 401(k) program with employer matching. They and their dependents residing in the US are eligible for medical, dental, and vision insurance.
Part-time temporary employees receive 6 days of paid sick leave each year (pro-rated for new hires throughout the year).
All US employees who work in a state or locality with more generous paid sick leave benefits than specified here will receive the benefit of those sick leave laws.
What We Believe
At UST HealthProof, we envision a bold future for American healthcare. Our values are the bedrock beliefs our organization holds dear. They not only define what our brand stands for but also serve as a compass guiding every action and decision.
Guiding Principles
These principles illuminate the path of ‘how’ we operate. They detail actions and behaviors we much embody to honor our values and achieve our goals.
· Simplicity
Simplifying complexity underlines everything we do—this approach is what makes us unique. We come with an open mind and straightforward approach, cutting our way to the core with measurable and actionable insights.
· Integrity
Integrity is our currency to build relationships. We believe in being open and honest. It is only natural when we have nothing to hide. It demonstrates that we are here to do the right thing, no matter who is watching.
· People-Centricity
Everything that we do reflects our deep bonds with peers and customers. These aren't mere transactions, but transformational ties. They shape our culture and decisions, affirming that our true value lies in the lives we touch and impact.
· Leadership
Taking ownership is about taking initiative, being in-charge and driving things to completion. It’s a brave choice to ‘own’ all aspects of our work, ensuring we take full responsibility for everything we handle.
Mission
A future possible only when health plans are free from administrative burdens so they can truly focus on what matters more – their members’ well-being.
Equal Employment Opportunity Statement
UST HealthProof is an Equal Opportunity Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other applicable characteristics protected by law. We will consider qualified applicants with arrest or conviction records in accordance with state and local laws and “fair chance” ordinances.
UST HealthProof reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.
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