ABOUT THIS ROLE
The Lead of Enterprise Stars Strategy works across the Bright Health organization to define, assign, and oversee best-in-class activities and Stars performance for all applicable lines of business, including Medicare Advantage and Individual and Family Plans. This individual is accountable defining best-in-class programs and targets, assigning accountability throughout the organization, overseeing performance, and ultimately line of business level performance. They will lead a cross-functional team which includes the operations team. This role will collaborate and partner with multiple stakeholders across the enterprise, but particularly the Clinical Market Performance Teams that are responsible for achieving quality gap closure in each market. In sum, this individual works with functions across the enterprise to develop, maintain, own, and execute strategies to improve overall Stars performance.
- Ownership of overall end-to-end stars strategy, execution and results
- Leads, develops, and executes strategies to improve operational effectiveness across Bright Health Stars programs
- Collaborates with the Bright Health Medicare teams, regional and local health plan business leaders to improve overall Star ratings for Medicare products
- Collaborates with the Individual and Family Plan team, and regional and local health plan business leaders to improve overall Star ratings for qualified health plans under the Accountable Care Act
- Ensures program compliance and identifies opportunities to improve service and quality outcomes
- Oversees the development and execution of Star program management policies, procedures, and guidelines; assists in developing clinical management guidelines
- Monitor and evaluate all initiatives, track progress and adjust strategy to achieve organizational goals.
- Act as the Bright Health Star program expert for both internal and external stakeholders
- Supports Star-related quality initiatives and activities across multiple business lines
- Responsible for developing and operationalizing both national and market specific strategies to ensure stars success
- Drives Stars program data and reporting solutions to measure ongoing performance
- Directs and prioritizes activities that ensure we achieve our overall Stars and quality objectives
- Presents stars results and ongoing performance measures to senior and executive leadership
- Monitor historical and current data trends in order to make recommendations and predictions
- Lead the organization to drive innovative initiatives that address low performing measures
- Develop comprehensive, provider-specific plans to increase their HEDIS stars performance and improve their outcomes
- Drives continuous improvement through a holistic and well-run performance improvement process
- Remain current and provide expertise around CMS Star measures, CHAPS, HOS guidelines
- Educate, advocate and influence regulatory and policy organizations on behalf of Bright Health
- Other duties and responsibilities as assigned
- This position has supervisory responsibilities.
EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE
- Ten (10) or more years of healthcare experience
- Strong demonstrated working knowledge of Medicare advantage and managed care
- Six (6) or more years of management experience inclusive of managing leaders in healthcare setting
- Experience with Complex Care Management clinical operations (Institutional or Community programs)
- Two (2) or more years of experience managing/implementing clinical products
- Seven (7) or more years of experience working directly within Stars, CMS, NCQA, including closing quality gaps
- Knowledge of regulatory quality-based reporting and audit requirements;
- Proficiency in interpreting results and formulating recommendations/action plans;
- Ability to research and analyze state/federal regulations related to health insurance and healthcare;
- Demonstrated skills in critical thinking, problem-solving, and the analysis, interpretation, and evaluation of complex information;
- Demonstrated ability to work independently;
- Excellent interpersonal, cross-functional coordination and communication skills.
- Strong project management skills;
- Strong verbal, writing and presentation skills;
- Computer skills: Microsoft Word; Excel; PowerPoint; and database software.
- Strong communication, time management and organization skills
- Demonstrated success in running and managing many projects at one time
- Demonstrated success in supporting internal clients and departments
The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer. Travel may be required.
At Bright Health, we brought together the brightest minds from the health care industry and consumer technology and together we created Bright Health: a new, brighter approach to healthcare, built for individuals. Our plans are easy to manage, personalized and more affordable, giving people the quality care they deserve. Through our exclusive care partnerships with leading health systems in local communities we are reshaping how people and physicians achieve better health together.
Bright Health is tripling its footprint in 2019 to offer a variety of health insurance plans to more individuals. Bright Health operates health insurance offerings across Individual and Family Plan segments and the Medicare Advantage space in Alabama, Arizona, Colorado, Ohio, New York and Tennessee.
We’re Making Healthcare Right. Together.
We've won some fun awards like: Great Places to Work, Modern Healthcare, Forbes, etc. But more than anything, we're a group of people who are really dedicated to our mission in healthcare. Come join our growing team!
As an Equal Opportunity Employer, we welcome and employ a diverse employee group committed to meeting the needs of Bright Health, our consumers, and the communities we serve. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.