Job Description

JOB SUMMARY

Under the direction of the Director of Quality, the Quality Manager is responsible for helping to develop, administer, and manage the CMS Medicare Stars and Quality programs at HealthTeam Advantage. Will collaborate with the Director of Quality and other internal and external teams to coordinate activities related to HEDIS, CAHPS, and HOS, and ensure programs provide high-quality care and service to our members and achieve the company's desired Star ratings; and ensure processes are in compliance with applicable laws and regulations.

ESSENTIAL DUTIES AND RESPONSIBILITIES

This position must be able to:

1. Implements and manages the strategic plans for the Quality Improvement/Stars program, including working with the Director of Quality to create goals and strategize for optimal outcomes across the company.
2. Creates internal and external educational pieces or leads the creation of these educational pieces for the Quality Improvement/HEDIS/Stars program with internal/external stakeholders.
3. Continually assesses the tactical processes to achieve program objectives; identifies and quantifies key drivers of the Star measures and Display measures; identifies areas of opportunity and improvement; and creates work plans/programs to address each.
4. Analyze trends and identify opportunities to improve organizational and departmental processes.
5. In Coordination with the Director of Quality, develops and manages work plans, establishes deadlines, assigns responsibilities, monitors overall project progress, and reports progress regularly to internal stakeholders as well as provider groups for Quality improvement or the Stars Program, Healthcare Effectiveness Data and Information Set (HEDIS), Health Outcomes Survey (HOS), Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.
6. Oversees Health Fair initiatives to facilitate work plans, identifying areas of opportunity and improvement.
7. Oversee vendor/provider group performance with HEDIS and Stars to ensure compliance with contractual obligations and service level agreements.
8. Collaborates across the company and with vendors to help ensure the integration and alignment of Star/HEDIS strategies
9. Leads and mentors the team assigned to Quality/HEDIS; provides guidance and support.
10. Demonstrates the ability to lead and influence others positively to achieve the desired goals of HTA.
11. Performs other duties as assigned

EDUCATION AND EXPERIENCE

Education:

Bachelor’s degree in business or a health-related field, or 6+ years equivalent work experience

Required Experience:

1. 2+ years of demonstrated experience with CMS Medicare Advantage Stars program, HEDIS, CAHPS/HOS, and Part D improvement strategies.
2. 3+ years’ experience in change management and process improvement
3. In-depth knowledge of care coordination, population health
4. management, pay for performance, and value-based agreements.
5. 4+ years of leadership experience
6. Experience working with vendors and budgeting.
7. Proficient in Microsoft Applications, Word, PowerPoint, and MS Excel Level 3- Expert. 
8. Strong organizational and communication skills.
9. Experience overseeing multiple projects and delivering outcomes.
10. Annual Flu Vaccine

Preferred Experience:

• Master’s degree in a health-related field, or clinical degree (RN, NP, PA, PharmD, etc.)

KNOWLEDGE, SKILLS, AND ABILITIES

Required Competencies:

• Working knowledge of HEDIS, CAHPS, HOS, and NCQA
• Working knowledge of Medicare Advantage and Part D laws and regulations

Strong in the following competencies:

• Proficient in Microsoft Applications, Word, PowerPoint, and MS Excel Level 3- Expert
• Decision making/Judgment/Strategic thinking.
• Problem-solving/Analysis/Strategizing across cross-functional teams.
• Communication
• Creativity/Innovation

PHYSICAL REQUIREMENTS

• Must be able to lift 10 lbs 

ABOUT HEALTHTEAM ADVANTAGE

HealthTeam Advantage is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.

HealthTeam Advantage (HTA), a Greensboro-based health insurance company, offers Medicare Advantage plans to eligible Medicare beneficiaries in 33 counties in North Carolina. HTA has been named a “Best Places to Work” finalist three times by  Triad Business Journal. To learn more, visit HealthTeamAdvantage.com.

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