Program Director, Medicare Star Ratings

HealthPartners is currently hiring for a Program Director, Medicare Star Ratings. The Program Director is accountable for organizational strategy and achieving HealthPartners' performance goals for the Medicare stars ratings of all Medicare products (e.g., MAPD, D-SNP, etc.). Specifically, this leader drives cross-functional execution of a multi-year strategy to achieve and maintain optimal star ratings.

The Program Director will develop effective working relationships with all levels of plan and care leadership and key stakeholders to ensure optimal star ratings are achieved and maintained. This role will lead cross-functional project/program teams and will collaborate with a variety of teams and partners to ensure the advancement of the Medicare Stars Program priorities.

Required Qualifications:

• Bachelor's degree in business, health care administration, health policy or other relevant discipline or equivalent years of related work experience.
• Ten years of professional experience in a health plan or managed care setting, with relevant work in Medicare Advantage.
• Four years of management experience and working with senior level leadership.
• Prior experience in driving and leading a Stars program with at least a 4-star overall star rating.
• Demonstrated ability to build, lead and direct cross-functional teams through a strategic planning process to meet business goals.
• Strong technical understanding of CMS star rating requirements.
• Excellent communication, facilitation, and presentation skills.
• Ability to navigate ambiguity in a complex and matrixed environment.
• Strategic critical thinking skills, with a high level of curiosity and openness to change.
• Proven leadership ability exemplified by a capacity to think strategically and implement tactically to consistently deliver results, well-developed skills in diplomacy and collaboration.
• Knowledge of computers including Microsoft Office (Word, Excel, PowerPoint, SharePoint) and reporting, database, analytics applications.

Preferred Qualifications:

• Master's degree in business, health care administration, health policy or other relevant discipline.

Hours/Location:

• M-F; Days
• May work remotely but will prefer local/regional candidates for occasional onsite needs.

Accountabilities:

• Accountable for the development, planning, prioritization, approval, and implementation of on-going Medicare Stars Program. Maintain a culture committed to star ratings success.
• Lead and implement 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. Work across teams to develop, deploy, and manage the dashboard and reports to enable at-least monthly evaluation of current performance on each measure.
• Build, lead and direct cross-functional teams through a strategic planning process to meet business goals.
• Develop strategic direction and directs cross-functional team activities throughout the organization to drive improvements in provider engagement, clinical care, data integrity, customer satisfaction, communication with members and providers.
  
  
  
  • Ensure development of risk mitigation and remediation strategies as risks arise.
  • For any measure performing below internal targets, ensure that department leaders have full understanding of the reason(s) that performance is below expectations and have designed and deployed adequate performance improvement activities to improve performance.
  • Ensure that all contracts (with providers, vendors, etc.) include SLAs related to Stars performance needs, are holistically designed to cohesively support the member's/provider's experiences, and comprehensively meet all star rating needs.
  
  
• Provide education, understanding and subject matter expertise regarding star measures, and highlight the significant business impacts of improved ratings throughout the organization. Includes executive understanding of stars performance and risk.
  
  
  
  • Responsible for coaching, providing direction to, giving feedback, addressing performance issues, and influencing team members and key partners, including senior leaders to help ensure goals of the Stars program are met. Perform other duties as assigned to ensure business needs are met.
  • Provide cross-functional Stars representation in initiatives, projects and workstreams, ensuring departments, operations, investments, tools, and resources meet Star needs and that all staff are trained and prepared to support Medicare members' needs.
  
  
• Stay up to date on industry and regulatory trends, including assessing and recommending responses based on evolving landscape, building a strong network of connections within and across the industry, and participating in ongoing training and development.
• Perform other duties as assigned to ensure business needs are met.