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, Oceanside , Vice President, Medicare Stars Programs, Executive , Rancho Cucamonga, California