Clinical Quality Program Manager II (CAHPS)

Job Summary

The Stars Program Manager (SPM) II is responsible for identifying, implementing, and guiding projects relating to quality excellence in Centers for Medicare and Medicaid Services (CMS) Five-Star Rating System and Marketplace Exchange Quality Rating Systems (QRS). The position is responsible for strategizing quality improvement programs and ongoing management using a data-driven focus that sets priorities for improvements aligned with ongoing strategic initiatives. This position collaborates with the Quality Improvement/ Quality Performance Management QI/QPM and Health Information Management (HIM) analytics support, Risk Adjustment, other plan operations business units, and network providers to strategize and promote success in achieving L.A. Care's enterprise wide quality goals and initiatives. 

The SPM will  develop and track the Stars work plan, implement short and long term operational goals to improve Stars ratings. The SPM will track, manage, and report project progress and outcomes. Manage vendor contracts. Facilitate collaboration with internal and external stakeholders to ensure that Stars initiatives are fully integrated throughout the organization.

Duties

Develop and maintain Stars work plan, convene committees and workgroups, and assist Stars Lead and Stars Core Team by leveraging technology and tools to streamline processes, enhance collaboration and synergy, promote data sharing, and improve transparency across clinical and operational areas.

Drive collaboration, education and training and maintaining working relationships across the Stars Core team and with multiple departments throughout LAC including but not limited to QI, Pharmacy, Care Management, Utilization Management, Risk Adjustment, Products, Customer Solution Center (CSC), reporting and Analytics, Appeals and Grievances and the provider network.

Manage and maintain the Stars SharePoint site to ensure all guidance from regulatory entities are available to key stakeholders and that enterprise-wide activities are documented and shared among accountable entities and network providers.

Coordinate workgroup meetings, send meeting reminders, format agendas, minutes and handouts. Manage the team SharePoint site. Follow up on meeting action items. 

Work closely with QI, Health Services, Reporting/Analytics, vendors, and the provider network on shared quality initiatives, data sharing and analyses. 

Monitor/track enterprise wide quality intervention and analytical strategies that elevate quality of care and enhance satisfaction for LAC members.  

Work closely with Stars Core Team (Stars Lead and Manager Stars Analytics) to lead quality reporting and analytical strategies to enable accountable entities and stakeholders to drive quality ratings improvement for Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Outcome Survey (HOS), Healthcare Effectiveness Data and Information Set (HEDIS), Medication Adherence and Plan Operations.  

Assist with identifying measures that need performance improvement, evaluate data, coordinate discussion/workgroup to develop strategy and work plan.

Research and implement best practices to improve population health, quality of life and evaluate impact.

Perform other duties as assigned.

Education Required

Education Preferred

Experience

Required:
At least 5 years experience in a health plan specializing in healthcare quality, informatics, QI initiatives and analytics.

Experience in implementing initiatives to improve quality ratings and managing projects and programs end to end.

Preferred Experience

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

Health Outcome Survey (HOS)

Skills

Required:
Thorough knowledge of health plan quality ratings and Stars.

Familiarity with HEDIS reporting and submission.

Demonstrated statistical analysis skills.

Must possess aptitude for accuracy and attention to details.

 
Proficient in Microsoft Office tools.

Ability to present data and analysis in a meaningful way, tailoring the message with audience in mind.

Excellent verbal, written and presentation skills.

Demonstrated critical thinking, problem-solving and process improvement skills.

Independent judgment and action skills to facilitate change as needed.

Knowledge of managed care industry standard performance assessment methods.

Able to work in a team environment, with good communication skills, supportive attitude and the ability to provide mentorship when appropriate.

Must demonstrate ability to work collaboratively and seek solutions proactively applying critical thinking skills in evaluating priorities and solutions.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training