At Mount Carmel, we work to continuously inspire one another. Here, all are welcome. It is this culture of humility and compassion that sets Mount Carmel apart. We see the big picture and do the right thing. That means a dedication to the well-being our both our colleagues and the patients they serve.
MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries in Ohio. We're dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.
Job Description Details:
HEDIS & Stars Program Manager is responsible for the implementation of the Star Measure requirements for Medicare managed care organizations. Responsible for the day to day operations of the Stars Performance Department. Responsible for the annual Star Performance Plan including oversight of staff required to develop, monitor, analyze and report related activities on an ongoing basis.
Reflects the skills, knowledge and attributes that individuals use as they serve in the role of a leader. The following provides examples of specific behaviors that correspond with Trinity Health leadership competencies:
Define and share a strategy and vision.
Align resources toward achievement of UEM results.
Grow and sustain the UEM.
Identify, lead and embrace change.
Meets population specific and all other competencies according to department requirements.
Responsible for day to day operations of the HEDIS and Stars Department.
Ensures the Plan meets the CMS Star Rating requirements.
Ensures the Plan meets the CMS and NCQA requirements for HEDIS rate production and required deadlines for HEDIS reporting.
Responsible for developing and updating policies and procedures based on regulatory and internal process changes.
Prepares the annual Plan for Star Performance Management.
Assists the Director, Stars with the development of the Star Performance Management Plan, associated work plan and annual summary of the program. Assists to update the work plan on an ongoing basis to reflect progress made on tasks and goals for the year.
Responsible for preparing the agenda, minutes and oversighting staff preparation for Star Operating Committee meetings.
Hires, trains, evaluates and supervises Star Performance colleagues.
Prepares presentations, training materials, manuals, audit tools and reports as needed.
Actively participates in activities to improve the Plan's Star ratings.
Uses principles of change management to facilitate organizational improvements.
Responsible for requests for proposals (RFPs) for CAHPS/HOS vendors as well as selection of vendor and monitoring of these contracted providers once selected.
Actively participates in related Committees and task forces according to the Star Performance Plan.
Education: Bachelor's Degree in health care field or nursing required or an equivalent combination of experience and education.
Experience: Two years of management experience. Experience in a provider sponsored Medicare managed care health plan preferred.
Familiar with Medicare Advantage and national quality standards and outcome measurement tools including HEDIS, CAHPS, and HOS.
Experience as an operational manager in a Medicare managed care plan preferred.
Experience making clear and concise verbal and written presentations to large groups.
Ability to clearly and concisely communicate with operational areas of MCHP.
Broad based management leadership experience with knowledge of complex systems and systems change with demonstrated success in tactical and analytical thinking.
Project management experience.
Knowledge of performance improvement systems, principles and designs.
Ability to proofread and edit the written work of others.
Demonstrates high tolerance for ambiguity and change while providing leadership to department staff and others to adapt effectively to meet changing environment.
Able to set and attain goals without direct continuous oversight management.
Discovering opportunities, support and excellence â“ all while making a real difference in patients' lives â“ begins at Mount Carmel. Find a new beginning and advance your career with us.
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, sexual orientation or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.