Medicare Stars Manager - ProspHire

As a Consulting Manager at ProspHire you will be a Firm leader, client delivery expert and mentor to junior staff. At a fast growing, 60+ person management consulting firm, this means you’ll use your problem-solving and resource management skills to manage growth and profitability of growing health plan accounts. You’ll cultivate and build relationships at all levels of a client organization to earn “trusted advisor” status while also serving as a mentor. You’ll get in the trenches and stand shoulder-to-shoulder with our health plan clients to solve their people, process and technology challenges.

The ideal candidate will have a strong background in HEDIS/Stars and experience leading a quality improvement program in accordance with the strategic goals of a health plan.

Requirements

·       Engage executive leadership on HEDIS/Stars strategy, make recommendations to address areas of concern and provide status on projected results

·       Collaborate with health plan leadership to develop processes to measure and collect data for HEDIS/Stars indicators

·       Implement a quality improvement program in accordance with the strategic goals of a health plan; Analyze and identify trends to develop improvement strategies and action plans for quality rating systems (HEDIS, QRS, Stars) across all lines of business

·       Manage quality initiatives and work cross-functionally with clinical and technical teams to develop the tools, processes and reporting required to ensure compliance with a complete and accurate coding and billing function

·       Provide timely monitoring of HEDIS/Stars program data submissions: CAHPS, HOS, HEDIS, etc.

·       Establish and communicate protocols and standards of care for the Medicare Advantage, Medicaid and ACA member populations while providing intervention guidelines based on current population health needs

·       Establish professional relationships with vendor partners, regulators, internal stakeholders and community agencies to facilitate quality processes

·       Closely follow CMS guidelines and translate into business strategies and tactics

·       Plan and lead client engagements; Facilitate buy-in of proposed solutions from clients; Define timing, manage resources and direct on-time, quality production of deliverables

·       Summarize and deliver information to clients through highly polished documentation and presentations; Communicate status, issues and risks to leadership

·       Develop and maintain relationships with key client decision makers; Lead, articulate and negotiate business cases for Firm’s service offerings; Consistently meet and exceed sales and managed revenue requirements

·       Appropriately forecast and manage engagement risk, budget and resources with the Firm and client

·       Mentor and coach junior team members, conduct performance reviews and support the Firm’s overall recruitment and retention efforts

·       Serve as a member of the Firm’s Leadership Team; Represent the Firm positively by building and maintaining strong relationships with professionals and team members at all levels

Qualifications:

·       A bachelor’s degree in a relevant field required; Master’s degree in healthcare or MBA preferred

·       Deep understanding of Medicare, Stars and HEDIS programs  

·       Experience managing programs and interventions through a full Stars cycle

·       8+ years’ professional experience in Health Plans, Payers or Government Programs, or a mix of a few years’ industry experience combined with consulting at the manager level

·       PMP or Six Sigma Black Belt certification preferred

·       Consulting experience preferred

·       Authorization to work in the U.S.

·       Ability to travel up to 50% of the time, if necessary; Our Firm has national clients

Benefits

·       Competitive compensation, plus bonus

·       Medical, vision and dental

·       401k with 4% match

·       Flexible time off and paid holidays

·       Paid parental leave

·       $500 annual wellness subsidy

·       Modern and cool workspace in Downtown Pittsburgh

·       Snacks (of course)