PacificSource Health Plans

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PacificSource is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status, such as race, religion, color, sex, sexual orientation, gender identity, national origin, genetic information or age. PacificSource values the diversity of our community, including those we hire and serve. We are committed to creating and fostering a work environment in which individual differences and diversity are appreciated, respected and responded to in ways that fully develop and utilize each person’s talents and strengths.

The Stars Program Manager is accountable for providing strategic direction, oversight, and achievement of PacificSource’s Medicare Star Rating goals. This role drives cross-functional execution of a multi-year strategy that ensures star ratings are achieved and maintained. The Stars Program Manager provides leadership, direction, and hands-on support to matrixed teams to deliver impactful initiatives that improve health outcomes. This role serves as Health Plan subject matter expert on the CMS Star Rating system and Technical Specifications.

Essential Responsibilities:

• Design, develop, and implement a multi-year work plan to achieve high Star Ratings performance and optimized success.
• Direct complex strategic projects and initiatives designed to support star rating performance. Work cross-functionally throughout the organization to ensure successful deployment and ongoing monitoring oversight.
• Lead cross-functional teams to provide recommendations, performance results and opportunity assessments for Star Rating improvement.
• Establish contract metric level goals to achieve an overall 4+ star rating; partner with cross-functional business leaders to develop, deploy, and manage monthly performance dashboards and leading indicators to proactively identify areas of potential risk.
• Collaborate with measure owners to analyze and transform performance to meet contract goals and maximize improvement opportunities.
• Partner with operational leaders across the enterprise to provide recommendations on opportunities for process improvements, organizational change management, monitoring, and other processes related to Medicare Star Ratings.
• Provide strategic direction of star rating activities, including prioritizing multiple work efforts simultaneously, ensuring key deliverables are completed and business goals are consistently met.
• Facilitate executive level Stars Steering Committee meetings to drive accountability and engage leadership on program performance, oversight and regulatory changes. Work with cross-functional business owners to ensure timely elevation of program risks, and present mitigation recommendations for executive endorsement, as needed.
• Ensure accurate data reporting for Star Ratings to maximize program outcomes. Analyze performance data from internal systems and CMS data sources to identify trends, opportunities, and risks.
• Proactively manage areas such as risk, budget/forecast, dependencies, etc. Prepare strategic analysis of potential business and/or operational opportunities as needed.
• Collaborate with clinical teams, member services, compliance, and operations, and oversee external vendors to ensure alignment with Star Rating objectives. Identify trends and areas for continuous improvement in member care and health plan performance, fostering a culture of ongoing enhancement in quality.
• Stay up to date on all CMS policies and changes impacting the Star Rating system. Ensure proactive all Stars-related activities.

Supporting Responsibilities:

• Meet department and company performance and attendance expectations.
• Follow the PacificSource privacy policy and HIPAA laws and regulations concerning confidentiality and security of protected health information.
• Perform other duties as assigned.

SUCCESS PROFILE

Work Experience: Minimum of five (5) years of experience in managed care with emphasis on Medicare Advantage, quality program compliance and/or operations. Experience in managing or improving Medicare Star Ratings and understanding of CMS quality measure required.

Education, Certificates, Licenses: Bachelor’s degree in healthcare administration, public health, or a related field, or equivalent years of additional relevant experience in lieu of degree required. Master’s degree preferred. Certified Project Manager (PMP) or ability to obtain certification within 1 year required.

Knowledge: In-depth knowledge of clinical quality measures (e.g., HEDIS, CAHPS, and other CMS quality metrics) required. Ability to excel in a highly matrixed organization and drive change management with internal partners. Proven track record in managing multiple high-risk, high-visibility, initiatives from definition through implementation. Strong leadership skills to guide cross-functional teams. Excellent written and verbal communication skills. Ability to analyze data, identify areas of improvement, and develop actionable plans to address challenges related to quality improvement. Adept in working with and presenting to executive level management and external stakeholders. Understanding of healthcare laws, regulations, and standards, especially those related to managed care, quality improvement, and compliance.

Competencies

Adaptability

Building Customer Loyalty

Building Strategic Work Relationships

Building Trust

Continuous Improvement

Contributing to Team Success

Planning and Organizing

Work Standards

Environment: Work inside in a general office setting with ergonomically configured equipment. Travel is required approximately 5% of the time.

Skills:

Accountability, Collaboration, Communication (written/verbal), Flexibility, Listening (active), Organizational skills/Planning and Organization, Problem Solving, Teamwork

Our Values

We live and breathe our values. In fact, our culture is driven by these seven core values which guide us in how we do business:

• We are committed to doing the right thing.
• We are one team working toward a common goal.
• We are each responsible for customer service.
• We practice open communication at all levels of the company to foster individual, team and company growth.
• We actively participate in efforts to improve our many communities-internally and externally.
• We actively work to advance social justice, equity, diversity and inclusion in our workplace, the healthcare system and community.
• We encourage creativity, innovation, and the pursuit of excellence.

Physical Requirements: Stoop and bend. Sit and/or stand for extended periods of time while performing core job functions. Repetitive motions to include typing, sorting and filing. Light lifting and carrying of files and business materials. Ability to read and comprehend both written and spoken English. Communicate clearly and effectively.

Disclaimer: This job description indicates the general nature and level of work performed by employees within this position and is subject to change. It is not designed to contain or be interpreted as a comprehensive list of all duties, responsibilities, and qualifications required of employees assigned to this position. Employment remains AT-WILL at all times.