Job Description

Job Title: Director, Medicare STARs
Job ID: 92104862
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Medicare/SNP STARS
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:
Responsible for all aspects of comprehensive program analysis for Medicare Star Ratings Program. This position drives and conducts: (1) research (e.g., conduct literature reviews to understand programmatic and regulatory changes), (2) reporting (e.g., competitive analysis), and (3) analysis (e.g., identify and explain trends, generate actionable insights) to support a portfolio of initiatives. This position develops business cases, identifies + research policy/advocacy initiatives, oversees development of new analytical tools, process maps and supports senior leadership to develop roadmap/ strategic planning efforts for creating a high performing Stars Program (4.5 Stars across all contracts). 


This position requires extensive client interactions and business plan and presentation + writing skills. Responsible for team of Managers and Business Analysts who perform day to day programmatic initiative implementation and data analyses. To successfully perform this role, the Director must understand the Star Ratings Program along with the current market trends in Medicare space. Maintains direct accountability for delivering the performance, reporting, financial or impact analysis, as well as strategic planning and budgets. This position will manage the organization of data and program information gathered to support and monitor the performance of the Health Plan's initiatives in accordance with the company requirements and customer expectations. 


The Director, Medicare Stars has comprehensive knowledge and expert understanding of Stars program and Quality to implement and drive the program initiatives and efforts to maintain the high Stars performance across all contracts. Furthermore, the position requires the ability to articulate these opportunities to internal and external audiences, implement the solutions, and track and monitor progress. These functions must be done while also weighing the practical considerations and potential barriers that exist when success

Responsibilities:

  • Monitor UPMC Health Plan operating performance against regional, national and international benchmarks. Mentor varying levels of Business Analysts
  • Participate in the development and implementation of the Medicare STARs strategic business plans and project plans to achieve Health Plan objectives. Responsible for all Medicare STARs supporting functions
  • Identify trends, investigate variances, and derive solutions to cost increases and quality issues. Implement and monitor effectiveness of analysis and recommendations.
  • Lead the analysis of claims experience, utilization, quality, membership and other statistics for all facets of the UPMC Health Plan resulting in recommendations that improve performance and demonstrate value. Develop, monitor and oversee product performance, including reporting that integrates Medicare STARs data as necessary.
  • Support development of training / mentoring curriculum that teaches varying levels of analysts how to effectively analyze and present recommendations and demonstrate value. Partner with subject matter experts in Finance, Operations, Clinical, Pharmacy, Sales/Marketing, and other areas to develop analyses and recommendations.
  • Support the UPMC Health Plan through timely and responsive research and analysis. Develop a library of standard analytical reports for internal use and presentation to external customers to support analysis and recommendations.
  • Inform and advise management of Medicare STARs of current trends, issues, problems and activities in functional areas, and develops and implements appropriate interventions to facilitate problem resolution and policy making in conjunction with changes resulting from corporate and ISD direction, as well as Healthcare Reform.
  • Mentor varying levels of Managers and Business Analysts

Qualifications

  • Master's degree in these same areas required.
  • HEDIS or similar Payer Quality Ratings System experience is a MUST with a strong preference to programmatic experience in Star Ratings program along with superb consultative skills and hands-on approach
  • Minimum of five years' experience in managed care and/or Medicaid, Medicare, or long-term services and supports.
  • Superior computer skills including Microsoft Access, Microsoft Excel, SAS, Crystal Reports, SQL, Toad, and other financial & statistical software packages.
  • Minimum of five years supervisory/management experience required
  • Strong prioritization and project management skills as well as in-depth healthcare business knowledge combined with thorough understanding of analysis and presentation, underlying business processes and the ability to assess how process changes impact organizational performance
  • Ability to proactively prioritize time-sensitive requests for information with finite resource.
  • Ability to negotiate effectively with other departments / divisions for knowledge transfer, influence and coach decision makers vis a vis best approaches, interpret results and advise internal customers on underlying trends / potential causes as well as recommended course of action
  • Person must demonstrate a high degree of professionalism, enthusiasm and initiative on a daily basis
  • Ability to work in a fast-paced environment a must Attention to detail is critical to the success of this position, with demonstrated competency in customer orientation and the ability to deal with ambiguity
  • Strong leadership skills and independent judgment and decision-making ability


Licensure, Certifications, and Clearances:

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $0 / hour

Union Position: No

Apply Current Employee?

UPMC VALUES

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.


WORKING HERE



Now more than ever, YOU can help us shape our communities and UPMC into a better place for everyone to work, study, play, and thrive.

Learn more about working here and check out our policies and recent updates.

UPMC Health Plan Named Best Places to Work for LGBTQ Equality in 2019


UPMC Ranked #1 Best Places for Women and Diverse Managers in 2019

Share:
Talent Network