Manager, STARS Member Experience

This is a fully remote position, open to applicants in Oklahoma.

📋 Description

• Offer guidance and training to the Quality department and staff across the organization involved in enhancing member experience initiatives.

• Oversee member experience survey ratings, including outreach to both members and providers.

• Design, strategize, and execute quality improvement initiatives for member experience while suggesting necessary changes.

• Lead member experience processes to align with NCQA accreditation standards and achieve a 4+ STAR rating.

• Ensure the monthly distribution of pre-CAHPS member surveys and relay results to external provider organizations.

• Establish and nurture relationships with internal departments and external providers regarding STARS and NCQA standards.

• Execute survey enhancement initiatives, including CAHPS committee meetings, aimed at boosting member survey scores.

• Create wellness materials for marketing purposes to aid in member retention and health improvement efforts.

• Maintain an expert-level technical understanding of HEDIS, CAHPS, HOS, NCQA, Meaningful Use, and CMS performance criteria.

• Oversee and evaluate the performance of the CAHPS/HOS survey vendor.

• Develop and implement the Medicare AWV/HRA program to enhance participation from both providers and members.

• Establish actionable objectives for the Quality Department to secure and uphold a 4 STAR rating.

• Produce training materials on member experience surveys for the entire organization.

• Uphold the confidentiality of business information and Protected Health Information (PHI).

• Act as a coach and mentor for roles that impact member experience ratings.

• Perform additional duties as assigned.

⛳️ Requirements

• A bachelor's degree or equivalent experience is required.

• A minimum of 5 years of experience in a clinical or health insurance environment is necessary.

• At least 5 years of experience in managing data to generate reports is required.

• Experience in medical quality, marketing, risk adjustment, coding, and/or wellness is preferred.

• A valid state driver's license is mandatory.

• Strong ability to communicate and manage complex professional relationships.

• Capability to train both internal and external stakeholders.

• Excellent organizational, verbal, written, time management, and telephone communication skills.

• Proficiency in computer applications, specifically Microsoft Word, Excel, and Outlook.

• Basic knowledge of electronic health records and a quick aptitude for learning new software.

• Comprehensive understanding of quality performance metrics and clinical healthcare processes.

• Ability to collaborate effectively across various departments.

• Commitment to maintaining the confidentiality of business information and PHI as mandated by HIPAA and company policies.

• Willingness to travel for presenting Quality survey updates to in-network provider groups and attending educational conferences.

• Ability to lift up to 25 lbs as needed.

🏝️ Benefits

• Affordable health insurance options available.

• Personalized, engaging, and responsive services for members.

• Opportunities for training and professional development through educational conferences and performance measure updates.

• Flexibility with remote work arrangements.

• Day shift hours.