Medicare Stars Senior Consultant

As a Medicare/Stars Senior Consultant at ProspHire, you will help define and execute medium to large-scale enterprise initiatives that deliver quality outcomes for our clients. You will also assist with Firm operations and business development and help cultivate an inclusive culture founded on relationships and relentless dedication to client service.

The ideal candidate will have experience demonstrating strong project management, business process and technical skills. They will also have a strong background in HEDIS/Stars and experience leading a quality improvement program in accordance with the strategic goals of a health plan.

Requirements

Engage leadership on HEDIS/Stars strategy, make recommendations to address areas of concern and provide status on projected results

Collaborate with health plan leadership to develop processes to measure and collect data for HEDIS/Stars indicators

Partner with leadership to implement a quality improvement program in accordance with the strategic goals of a health plan; Analyze and identify trends to develop improvement strategies and action plans for quality rating systems (HEDIS, QRS, Stars) across all lines of business

Manage quality initiatives and work cross-functionally with clinical and technical teams to develop the tools, processes and reporting required to ensure compliance with a complete and accurate coding and billing function

Provide timely monitoring of HEDIS/Stars program data submissions:CAHPS, HOS, HEDIS, etc.

Establish and communicate protocols and standards of care for the Medicare Advantage, Medicaid and ACA member populations while providing intervention guidelines based on current population health needs

Establish professional relationships with vendor partners, regulators, internal stakeholders and community agencies to facilitate quality processes

Closely follow CMS guidelines and translate into business strategies and tactics

Develop an in-depth understanding of the client's business and make strong contributions to business development

Directly supervise, manage and mentor Firm team members on projects; Identify and resolve risks related to team and projects

Apply knowledge of organizational change management and design, development and implementation processes to deliver measurable, sustainable solutions

Help clients define success and establish metrics to track business objectives; Define the "as is" and "future state" of business, operations and technology issues

Critically evaluate information from multiple sources, reconcile conflicts and distinguish user requests from true underlying needs

Develop and manage a project plan; Identify tasks, define timing and manage resources accordingly

Summarize and deliver information to clients through documentation and presentations; Communicate status, issues and risks to high-level executives

Build and maintain personal and professional client relationships; Work well with different personalities

Create a positive work environment and foster open communication

Qualifications:

A bachelor's degree in a relevant field

5+ years' experience driving, managing and delivering medium to large-scale business solutions

Deep understanding of Medicare, Stars and HEDIS programs

Authorization to work in the U.S.

Ability to travel up to 50% of the time, if necessary; Our Firm has national clients

Benefits

Competitive compensation, plus bonus

Medical, vision and dental

401k with 4% match

Flexible time off and paid holidays

Paid parental leave

$500 annual wellness subsidy

Modern and cool workspace in Downtown Pittsburgh

Snacks (of course)

Qualification

Bachelor's Degree