STARS Program Manager

The Stars Program Manager is responsible for the oversight and success of the Stars ratings for Medicare Advantage, Medicare Prescription Drug, and ACA Individual Plans. The position will work jointly with Government Programs, Pharmacy, Marketing, Sales, Provider Relations, Medical Affairs, Compliance, Customer Service, and Information Technology and Services to monitor and ensure high Stars ratings. The position will engage with and integrate multiple vendors into our operations to maximize Stars ratings.

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“This position is eligible to work onsite or hybrid (9 or more days a month onsite), or remote in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

Why Join Us?

• Family Comes First: Total rewards package that promotes the idea of family first for all employees; including paid time off and family first leave.

• Professional Growth Opportunities: Advance your career with ongoing training and development programs both through our internal Blue University and external opportunities.

• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.

• Stability: 80 years of commitment, compassion, and community

• Lead and Inspire: Guide and mentor your team to achieve their full potential and success.

• Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire

Compensation

$96,800- 115,000

Exempt 17

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training.

What you’ll do

• Maintain subject matter expert knowledge of CMS and Stars program requirements and methodologies.
• Coordinate review of Stars results in accordance with internal and federal requirements to optimize revenue. Maintain reporting and modeling tools to achieve that end and identify and develop Stars improvement plans.
• Review CMS Communications pertaining to Stars. Propose policy and procedure changes to comply with any new CMS requirements.
• Coordinate the development of Stars improvement initiatives and incentive programs and lead their cross divisional execution through interpersonal influence and project management best practices.
• Participate in the annual Health Effectiveness Data and Information Set (HEDIS) audit activities and other Stars reporting and audits.
• Analyze HEDIS data, including data audits, roadmap (data flow processes) documentation reports, statistical analysis, medical record extraction, and other HEDIS-related activities as needed.
• Present Stars initiatives and results to leadership
• Expand knowledge of industry best practices and trends in Stars improvement initiatives while tracking the outcomes. Maintain the analysis and tracking models as needed and identify/develop model improvements.
• Support the identification, gathering, organizing, and analyzing of data sources, both internal and external, that improve our knowledge of enrollees and opportunities for enhanced Stars reporting. Propose alternative data sources and process improvements where possible.
• Coordinate internal Stars Committee and conduct any sub team meetings as needed. Report activities accordingly.

What you need

Knowledge/Skills/Abilities

• Must possess advanced analytical, problem-solving, and research skills
• Must have the ability to see and anticipate significant issues or trends affecting Stars upon the completion of training.
• Develop knowledge, skill and abilities in Stars theories, practices, and technologies.
• Ability to work with computer programming and PC data analysis tools.
• Skilled with Microsoft Word, Excel, PowerPoint, and database management tools,
• Must effectively use interpersonal and communication skills with tact and diplomacy. This position maintains interaction with vendors and employees throughout the company.
• Must have experience working on multiple ongoing projects and exhibit the capacity to lead projects.
• The ability to work well independently or with other employees, leadership, and vendor staff is expected.

Education and Experience: 

• Bachelor’s degree in mathematics, Statistics, Finance, Health Care or Business Administration, Management is required.
• Proven experience within an MA Stars program is preferred. Multiple years’ experience with Stars data analysis/reporting is preferred.
• Experience and knowledge in the healthcare delivery system, insurance, finance and health industry is critical. Knowledge of compliance, information technology systems, and other health insurance concepts and principles is preferred.

Benefits & Perks

• Base pay is only one component of your competitive Total Rewards package:
• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 5% 401(k) plan matching
• Tuition reimbursement
• Health & fitness benefits, discounts and resources