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Medicare Stars Member Experience Lead

HMSA
Honolulu, HI Full Time
POSTED ON 3/13/2025
AVAILABLE BEFORE 4/2/2025
  • Monitors member experience indicators and identifies opportunities for improvement.
  • Serves as subject matter expert on Medicare CAHPS performance indicators and trends.

    • Leads the development of data collection and reporting methods to monitor member experience and Medicare CAHPS performance.
    • Monitors and analyzes member experience indicators and Medicare CAHPS outcomes to ensure goals, objectives, outcomes are met.
    • Monitors for adverse trends, performs root cause analysis, recommends process improvement modifications and corrective actions.
    • Works within HMSA, and with BCBSA, providers and vendors to review best practices, programs, and processes for improvement opportunities. Responsible for bringing forward recommendations to the Stars leadership team.
    • Leads the development and implementation of short-term and long-term strategies to ensure we meet health plan Medicare CAHPS goals.
    • Champions a blend of quality improvement methodologies as the framework for supporting member experience initiatives.

    • Works with internal and external stakeholders to develop and implement initiatives that make effective use of resources.
    • Manages priorities, resource constraints, project issues and other factors to ensure that timelines and deliverables are understood and achieved.
    • Ensures that quality improvement processes and documentation support CMS Medicare Star Ratings guidelines and requirements.
    • Acts as the lead of Medicare member experience initiatives. Collaborates with cross-departmental business leaders and external partners to achieve common goals.
    • Provides Medicare CAHPS education and to the whole organization and external partners.

    • Provides Medicare CAHPS performance reporting to all levels of staff including executive leadership.
    • Leads and / or participates in internal and external activities, workgroups, meetings, etc. that support Medicare CAHPS performance.
    • Develops strong business partnerships with key areas throughout the organization and external partners to continually improve Medicare CAHPS performance.
    • Seeks opportunities to support Medicare CAHPS performance through external provider programs (e.g., Payment Transformation, Advanced Hospital Care, value-based payment arrangements, etc.)
    • Performs all other miscellaneous responsibilities and duties as assigned or directed.
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