The Manager, Medicare Quality role is fully accountable for the CMS 5-Star Quality program for Priority Health Medicare. It is responsible for creating a comprehensive program management plan with initiatives to improve our quality rating. Responsibilities include identifying, creating and leading initiatives, working with cross-functional groups to execute the Five Star Quality plan.
Experience requirement additions:
Prefer 1+ year experience with Five Star Medicare Quality initiatives
Serves as Priority Health's SME regarding Five Star Quality. Responsible to create new, strategic initiatives to increase our quality scores.
Organize and maintain open lines-of-communication with internal and external customers to ensure product and operational information is up-to-date and accurate.
Manage and facilitate cross functional teams to represent all domains of Medicare quality to increase performance. Leads laterally and exercises influence to achieve desired outcomes.
Act as subject matter expert on quality standard bodies such as CMS (Centers for Medicare & Medicaid Services), JNC (Joint National Committee), NCQA (National Committee for Quality Assurance), etc. as well quality metrics such as HEDIS, HOS, CAHPS.
Collaborate with clinical and other health plan staff to measure and evaluate quality, utilization, member experience and outcomes, as well as medical cost.
Identify, coordinate and support activities around initiatives to increase quality, including but not limited to: vendor evaluation and selections, data analysis, budget management and process improvement facilitation.
Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected category.