Vice President, Medicare Stars Programs
Company: Inland Empire Health Plans
Location: Rancho Cucamonga
Posted on: October 19, 2024
Job Description:
What you can expect!Find joy in serving others with IEHP! We
welcome you to join us in "healing and inspiring the human spirit"
and to pivot from a "job" opportunity to an authentic
experience!The Vice President of Medicare Stars Programs is
accountable for health plan strategy and achieving IEHP's
performance goals for the Part C and D Medicare Stars programs for
all Medicare products (e.g., D-SNP, MA-PD, etc.) and related
programs that influence that Stars rating. The proven leader will
devise and implement Medicare Stars strategies across the
organization to achieve demonstrable improvements in the Plan's CMS
Star Ratings measures. Specifically, this role is accountable for
IEHP's CMS Star Ratings performance to be at least 4 stars on a
continuous basis. In addition, the leader must develop effective
working relationships with key stakeholders across the organization
and with IEHP's Provider Network, in collaboration with business
units such as the Provider Network and Health Services team, to
ensure optimal Star Ratings are achieved and maintained for IEHP.
The Vice President, Medicare Stars Programs will collaboratively
work with teams across business units at IEHP and ensure the
advancement of Medicare Stars Program priorities.Key
Responsibilities:
- Plan, develop, and implement effective improvement strategies
to achieve high performance for Medicare Part C and D Stars.
- Lead and implement Medicare Stars-related measure performance
analytics with an aim to identify areas of opportunity, key
drivers, and assessment of the impact on quality improvement
related activities to impacting measure performance.
- Effectively lead and partner with cross functional business
units in planning and executing Stars improvement strategies and
programs. Key functional areas supported include developing and
executing new Stars performance improvement initiatives, managing,
and standardizing existing Stars improvement projects, evaluating
and optimizing programs to deliver impact, and Stars reporting and
compliance.
- Develop strategic direction, training, goals, and coaching
plans for Medicare Stars Team and cross-functional IEHP Teams
supporting Stars programs.
- Effectively lead cross functional teams to implement Medicare
Stars measure level improvement interventions across all key
categories of the Stars Program and partnering with both internal
and external resources.
- Develop strong relationships with the IEHP Provider Network
team to be able to effectively communicate new requirements and
opportunities around clinical workflow, data reporting, and support
services to optimize Quality outcomes, including IEHP Pay for
Performance results.
- Influence thought leadership regarding measure level
improvement opportunities and serve as a subject matter expert in
meetings and discussions.
- Collaborate with cross-functional teams to assure regular
tracking of Stars program KPIs to inform timely follow-up,
escalation of gaps and barriers, and advancement of innovative
workflows to support and promote quality improvement
initiatives.
- Establish policies that support morale and engagement, team
member retention, staff development and growth.
- Support the oversight to the departments' operations to ensure
it is fully compliant service with all regulatory
requirements.
- Perform any other duties as required to ensure Health Plan
operations and department business needs are successful.Commitment
to Quality: The IEHP Team is committed to incorporate IEHP's
Quality Program goals including, but not limited to, HEDIS, CAHPS,
and NCQA Accreditation.Perks:
- CalPERS retirement
- 457(b) option with a contribution match
- Generous paid time off- vacation, holidays, sick
- State of the art fitness center on-site
- Medical Insurance with Dental and Vision
- Paid life insurance for employees with additional options
- Short-term, and long-term disability options
- Pet care insurance
- Flexible Spending Account - Health Care/Childcare
- Wellness programs that promote a healthy work-life balance
- Career advancement opportunities and professional
development
- Competitive salary with annual merit increase
- Team bonus opportunitiesEducation & Experience:
- Minimum of ten (10) or more years of current progressive,
operational experience in a health plan or managed care setting
with a focus on excellent process and execution. Prior Experience
in driving and leading at least a 4-star Medicare or Medicare
Advantage Stars Rating. Specific rollout and implementation
experience in achieving at least a 4 Star rating for Medicare Stars
and/or Medicare Advantage in a non-integrated healthcare setting
consisting of diverse provider types, including solo, small and
medium size practices, as well as IPA's. Five (5) years of strong
senior level leadership/management experience is required.
- Bachelor's degree in a related field from an accredited
institution required.
- Master's degree or higher in healthcare administration,
nursing, hospital administration, business, public health, or
related field from an accredited institution preferred.Key
Qualifications:
- Must have a valid California Driver's license and valid
automobile insurance. Must qualify and maintain driving record to
drive company vehicles based on IEHP insurance standards of no more
than three (3) points.
- Knowledge of computers including Microsoft Office (Word, Excel,
PowerPoint) and reporting, database, analytics applications.
- Strong managerial, motivational, and presentation skills.
- Clinical data analysis and trending skills.
- Training, teaching, and mentoring skills.
- Decision making and problem-solving skills.
- Skilled in supervising and leading high performing teams to
meet deadlines.
- Superior communication skills, at all levels of the
organization, including writing and presentation skills.
- Attention to detail. Ability to work independently and within a
team environment.
- Change agent. Customer service orientation.
- Technical understanding of Health Plan Part C requirements
including, but not limited to, staying healthy measures, managing
chronic long-term conditions, member experience, member complaints,
and customer service.
- Technical understanding of Health Plan Part D requirements
including, but not limited to, drug plan customer service, member
complaints, member experience, and drug safety and accuracy of drug
pricing.
- Specific operational understanding of the differences in
achieving a 4-star rating in an integrated vs. a non-integrated
healthcare system.
- Strong knowledge of current regulatory requirements for Part
C/Part D measures.
- Strong knowledge of CAHPS, member experience, and access
measure performance.
- In-depth knowledge of coding and documentation training
programs for the provider network to support effective Medicare
Star measure performance.
- In-depth knowledge of supporting finance teams in the improved
coding accuracy and improvement in the year-over-year Risk
Adjustment Factor associated with the attributed population, with
an understanding of fee for service and capitation.
- Understanding in building high performing teams, as well as
leading teams.Start your journey towards a thriving future with
IEHP and apply TODAY!
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Keywords: Inland Empire Health Plans, Lakewood , Vice President, Medicare Stars Programs, Executive , Rancho Cucamonga, California
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