Director, Medicare Stars

Position Title: Director, Medicare Stars
Department: Medicare Administration
Title of Manager: Vice President, Medicare
Supervises: Non-Supervisory position
Exemption Status: Exempt
Requisition ID: 20727

Job Summary
This position is responsible for leading the development and oversight of Medicare Stars strategy and activity for the organization and provider network. Core responsibilities include technical leadership and planning, as well as education and relationship management.

Education and/or Experience
Minimum 10 years’ experience in healthcare, insurance, social services, operations, quality, or related area, including minimum 3 years in provider relations, technical support functions and/or health plan operations
Minimum 4 years’ supervisory experience
Experience in designing and implementing practice-level quality improvement programs
Management experience in a managed care organization or provider practice setting
Value based payment development or implementation experience

Essential Responsibilities
Technical/Operational Leadership
Leads the development and execution of strategic initiatives, plans, and goals in alignment with organizational vision and goals of the Medicare Stars program.
Develops and ensures internal systems and measures are in place to effectively monitor performance.
Participates in CMS Bid teams as the SME for Stars performance and benefit design to support Stars.
Oversees internal and vendor work to target interventions for Stars performance at both member and provider levels.
Creates a culture for Stars awareness; serves as the organization’s primary resource in designing internal and external training materials for Stars content.
Works with marketing and communications staff to design annual Stars campaigns for provider network.
Guides work of data analytics staff in producing Stars dashboards and provider-facing report cards.
Contributes to budget planning as related to Stars work and performance.
May serve as a sponsor or chair for key projects and initiatives.

Strategic/Operational Planning
Participates in the development of department vision, goals, and strategic plans.
Develops short and long-term plans and policies; oversees the development and execution of standard operating procedures.
Provides input into the strategic plans of the organization.
Maintains a business unit and member view while establishing department priorities, being cognizant of broader business unit and organizational impacts.

Relationship Management
Leads effective communication system with work group(s), ensuring a collaborative culture.
Builds and ensures effective relationships across internal teams and external organizations.
Partners with internal leaders and managers in identifying improvement plans and processes.
Represents CareOregon in external meetings and functions, providing productive leadership presence and effectiveness.

Organizational Responsibilities
Perform work in alignment with the organization’s mission, vision and values.
Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals.
Strive to meet annual business goals in support the organization’s strategic goals.
Adhere to the organization’s policies, procedures and other relevant compliance needs.
Perform other duties as needed.

Knowledge, Skills and Abilities Required
Extensive knowledge of managed care and Medicare Advantage plans and regulations
Knowledge of federal Medicare regulations and state Medicaid rules (OARs)
Knowledge of physician group, hospital, and facility operations and quality improvement
Knowledge of clinical workflows and models, including extensive knowledge of special needs patient care and Medicare quality metrics
Knowledge of learning collaborative and practice facilitation strategies
Strong abilities in building relationships with multiple entities, including providers and community stakeholders
Skilled in strategic thinking and executing strategy effectively; ability to think at an enterprise level
Leadership effectiveness and ability to design and implement constructive change
Excellent critical thinking, analytical and problem-solving skills; ability to effectively analyze program goals and objectives to determine successes and opportunities for improvement
Ability to effectively convey business unit goals and plans ensuring integration into strategic plans and initiatives
Ability to communicate effectively, both verbally and in writing, including strong presentation and change management skills
Ability to influence and build consensus
Ability to work in an environment with matrix reporting, diverse individuals and groups

Physical Skills and Abilities Required
Lifting/Carrying up to 10 Pounds
Pushing/Pulling up to 0 Pounds
Pinching/Retrieving Small Objects
Climbing Stairs
Repetitive Finger/Wrist/Elbow/
Shoulder/Neck Movement
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0 hours/day
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More than 6 hours/day

Speaking Clearly
0 hours/day
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More than 6 hours/day
More than 6 hours/day
More than 6 hours/day
More than 6 hours/day

Cognitive and Other Skills and Abilities
Ability to focus on and comprehend information, learn new skills and abilities, assess a situation and seek or determine appropriate resolution, accept managerial direction and feedback, and tolerate and manage stress.

Working Conditions
Environment: This position’s primary responsibilities typically take place in the following environment(s) (check all that apply on a regular basis):
☒ Inside/office ☐ Clinics/health facilities ☐ Member homes
☐ Other_________________________________________
Travel: This position may include occasional required or optional travel outside of the workplace, in which the employee’s personal vehicle, local transit, or other means of transportation may be used.
Equipment: General office equipment
Hazards: n/a
Candidates of color are strongly encouraged to apply. CareOregon is committed to building a linguistically and culturally diverse and inclusive work environment
Veterans are strongly encouraged to apply.
Equal opportunity employer. This company considers all candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.

Position Description »