Director, Medicare Star Quality Programs' Performance Management - Advantasure

Job Description

At UST HealthProof , you will join a fast-paced, growing company in our mission to reshape the future of health insurance by significantly reducing administrative costs and building better healthcare experiences for our health plan customers and their members. By creating a modern, cloud-based, Best-In-Class core administration ecosystem, we have made healthcare more affordable and helped our health plans operate more efficiently. Through member and provider touchpoints with less friction, we have created a real impact for members. **

UST HealthProof** is run by leaders with strong health plans and technology backgrounds a startup mindset and an environment of support where individual growth is nurtured. You will be supporting our proven core admin solutions and business process-as-a-service (BPaaS) operations to provide transparency, improve operational efficiency, break down operational barriers to scale, and drive strategic growth.

Visit us at UST.com **

You Are**

The Director of the STARS Quality Programs Performance Management is responsible for the management of multiple functions including end-to-end star performance management, forecasting, trending and analytics, client management, and client strategy. This includes assistance with product strategy, research, and development of new technology solutions, monitoring industry trends, managing overall client relationships and star performance, and vetting and prioritizing new solutions based on client needs and, utilizing. The position will require significant creativity, organization, motivation, and attention to detail as star management and the initiative portfolio are critical to the success of the quality product. **

The Opportunity**

Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; and supporting and encouraging the engagement process.

• Leads cross-functional Medicare Advantage Operating Team, to include Directors from across the client & Advantasure enterprises that are accountable for the success of this line of business. Influences and collaborates with others to execute operational priorities within the Medicare & Consumer Operations strategy.
• Develops strategy for data analytics used for Stars forecasting and client and client competitor trending
• Acts as SME for the development of product and technology strategy and execution
• Responsible for overseeing all issue management: triage, prioritization, communication, and tracking implementation of resolution cross-functionally.
• Partners with key internal partners – e.g. internal & client external Star Team - to ensure timely issue resolution and coordination of cross-channel member communications for Medicare members.
• Monitors and identifies opportunities for process improvements, builds business cases to support improvement opportunities, and works cross-functionally to build support for approval of these initiatives.
• Defines and executes strategies to drive operational efficiency and self-service capabilities, in partnership with Product and technology divisions and other accountable leaders within the matrix, to improve P&L performance around client accounts, G&A, supporting client enrollment and retention goals.
• Directs and implements various Medicare workgroup deliverables to ensure they support business objectives and meet all compliance requirements.
• Proactively monitors all contractual and regulatory client & vendor SLAs and develops internal SLAs where necessary to ensure performance standards are being met. Develops and manages operational dashboards that emphasize the overall health of the Medicare Advantage business.
• Manages processes to collect, review, and submit risk, quality, and service metrics reporting and, ensure reports are submitted as required.
• Develops and maintains collaborative relationships with client leaders and third-party partners.
• Assesses program capacity and capabilities for meeting CMS requirements and oversees SME support of initial and annual client implementations, key business functions, processes and the departments supporting Medicare Advantage.
• Coordinates functions and communications throughout the organization as a “hub” to ensure the successful delivery of the Medicare program.
• Directs and manages the implementation of new CMS program requirements and transfers operational ownership to the appropriate department once implementation is complete.
• Ensures Medicare program and products meet all regulatory requirements.
• Determines, develops, and continually improves objectives and policies for the Medicare program and identifies and resolves any issues that may hinder program success.
• Research potential initiatives that will drive Star performance across clients
• Supports internal transparency and client expectations through clear strategy updates and implementation statuses
• Coordinates executive-level status and budget impact of tactical and strategic initiatives
• Leads business aspects of project management to ensure accuracy, consistency, efficiencies, and timelines
• Influences and supports the culture, values, and standards of the organization.
• Directs, motivates, and develops the staff who report to them
• Directs the review of tools and technologies for improving performance and reducing costs.
• Works closely with Business Unit Support and with appropriate business areas to ensure that business needs are understood and that services provided meet those needs.
• Performs leadership duties, including performance reviews.
• Provides vision, leadership, planning, project coordination, and management for the development of a cost-effective department, while concurrently facilitating efficient operations to meet current and future business needs within the organization.
• Participates in the development of programs as a strategic partner that supports the company plan.
• Participates in the development of annual departmental budget and monitors budget

What You Need

Bachelor’s degree in a related field. Master’s degree in a related field preferred. Continuous learning, as defined by the Company’s learning philosophy, is required.

Ten (10) years of progressively more responsible experience in a related environment with demonstrated technical experience that provides the necessary knowledge, skills, and abilities. Five (5) years of management or supervisory experience in a related field is required.

• Subject matter expertise in Medicare Stars and deep knowledge in HEDIS measures
• Stars rating and forecasting capabilities including but not limited to deep knowledge of the analytics & reporting tools needed to assist with product technology development
• Market trends and regional competitor trending ability
• Stars rating strategy development
• Strong ability to communicate with clients and stakeholders
• Ability to influence stakeholders and foster partnerships that drive higher Stars rating performance
• Strong leadership skills
• Excellent documentation skills
• Ability to work with mathematical concepts such as probability and statistical inference, and basic algebraic functions. Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Must demonstrate leadership ability and team-building skills to effectively supervise professional and non-professional staff and interact with all levels of management.
• Ability to work with and empower others on a collaborative basis to ensure the success of the unit team.
• Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques.
• Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.
• Ability to establish workflows, manage multiple projects, and meet necessary deadlines.

Bonus Points If

Certification or progress toward certification is highly preferred and encouraged.

_Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by local law, UST provides a reasonable range of compensation for roles that may be hired in California, Colorado, New York City, or Washington as set forth below.

_ Role Location: Remote

Compensation Range: $126,000 - $156,000 **

What We Believe

**_We’re proud to embrace the same values that have shaped UST since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone to champion diversity and inclusion and to place people at the centre of everything we do.

_ _Humility: We will listen, learn, be empathetic, and help selflessly in our interactions with everyone.

_ _Humanity: Through business, we will better the lives of those less fortunate than ourselves.

_ _Integrity: We honour our commitments and act with responsibility in all our relationships.

_ _**Equal Employment Opportunity Statement

**_ _UST is an Equal Opportunity Employer.

_ _All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

_ UST reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.