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Manager of CMS Stars Performance - 043317


POSITION SUMMARY:
To be fully engaged in providing Quality/No Harm, Customer Service and Stewardship by improving member health, STARS performance, and NCQA adherence through member engagement initiatives. The incumbent will provide leadership and oversight of team operations, developing and implementing a strategy for improving plan performance by influencing the experience, wellness, and health outcomes of the customer population, as well as ensuring the documented processes and procedures support a culture of continual improvement while meeting all regulatory and accreditation requirements. The role will be directly responsible for the oversight of STARS performance and NCQA accreditation measure achievement, collaborating with operational leaders to develop and implement performance improvement initiatives. Additionally, the leader will be responsible for creating a process for receiving, generating, and reviewing communications requests from all Health Plan departments, and maintaining an inventory system used to manage all communications, document and report measures related to Regulatory, Operational, and Marketing requirements, and serve as the primary source for all member communications campaigns.

PRIMARY ACCOUNTABILITIES:
Facilitate intra-departmental workgroups to establish and monitor corrective action plans, interventions, process changes around QI annual reports, e.g., CAHPS analysis, GEO Access and Availability, quality improvement team actions and outcomes. Coordinate with key departmental leaders to ensure ongoing and year-end analyses are being completed that appropriate interventions and actions plans for opportunities for improvement are being implemented
Leverage skills to achieve efficiencies and contribute to creating an insurer of choice for current/prospective customers and a workplace of choice for associates. Success will be based on the individual's professional ability to lead a team toward a common goal, effectively communicate and manage complex regulatory issues, and convey the how each campaign contributes to the Health First mission
Engage associates by creating a positive and competitive workplace, implementing action plans resulting from associate feedback and associate engagement surveys
Oversee the ongoing completion of accreditation document submission and preparation of documentation for scheduled surveys and other regulatory audit activity.
Review and approve or deny communications to ensure each piece is professionally written, grammatically accurate, correctly structured, provide the necessary content, and meets all other internal requirements and expectations
Lead team in developing strategies, key messages, and vehicles for communication to support member wellness and experience initiatives
Collaborate with compliance and government relations to ensure timely submission of required reports and data
Oversight of all preparations for accreditation site surveys
Present information and regular reports to management and QI committees on the accreditation maintenance plan and status of accreditation compliance and preparedness
Collaborate with health plan management teams on any/all pertinent accreditation/regulatory activity or quality process for the Health Plan


QUALIFICATIONS REQUIRED:
Bachelor’s Degree in Healthcare, Business, Communications, Marketing, or a related field
3 years of experience in insurance, technical writing, communications, or related field, preferably in the Health Care industry
3 or more years of experience in progressive leadership
3 years accreditation and or regulatory experience, preferred
Strong organizational skills and attention to detail
Strong motivation to achieve personal, departmental, and organizational goals
Aptitude for proofreading and editing
Experience using various platforms for creating, editing, and distributing communications, including extensive experience using Microsoft products
Personal computer skills a must, proficient in word processing, graphics and spreadsheet manipulation and basic understanding of the Internet
Exceptional interpersonal relationship skills
Demonstrates excellent written and verbal communication skills conforming to all rules of punctuation, grammar, diction and professional style
Presents professional image to the public
Experience in initiating, developing and monitoring policies, internal control procedures and operating standards

PHYSICAL DEMANDS:
Ability to work flexible and/or long hours at a desk using computers, telephone and a variety of other automated office machines
Ability to work in various office environments

Time:  Full time
Salary:  Salary
Category:  Administration

Updated: 8/1/2019 3:55:41 AM

Job Contact:
Nicole Kelling
321.473-1795

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6450 US Highway 1
Rockledge, FL 32955

321.473-1795