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STARS Standards Specialist

STARS Standards Specialist

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4431

Job Description

Overview

The Stars Standards Specialist core function includes assuring ongoing organization-wide activities in support of the Centers for Medicare and Medicaid Services (CMS) Star Rating Program for Medicare Advantage.  Core functions also include responsibility for all quality related activities to include, but not limited to accreditation and regulatory efforts associated with or required by the National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information Set (HEDIS), a registered trademark of NCQA, the Department of Medical Assistance Services (DMAS), the Centers for Medicare and Medicaid Services (CMS) and other required entities associated with or required by the State and/or Federal Government. The Stars Standards Associate shall also be responsible for serving as the plan’s expert and liaison for Star Measures quality standard requirements.  Travel is mandatory.

Responsibilities

  • The primary responsibilities of the Stars Standards Specialist will be to work with others across all departments to assure adherence to the CMS Standards for Medicare Advantage.
  • Lead cross organization work teams in efforts to improve Star Ratings
  • Responsible to oversee the monthly updates to the Stars dashboard
  • Collaborate closely with all members in the Quality Department to assure streamlined, efficient processes are in place and meeting the needs of both the Medicare Advantage Prescription Drug (MAPD) and Medicaid plans
  • Ensure ongoing compliance to accreditation and/or regulatory standards through auditing, assessment, data collection, tracking, monitoring, analysis and feedback/recommendations on improvements
  • Develop and monitor the completion of work plans and project plans
  • Implement activities, interventions, and/or deliverables as defined in the work plans, project plans or other format for departments throughout the organization
  • Conduct cost analyses related to implementing various quality related activities
  • Conduct internal (e.g., departmental and organizational) and external educational orientations related to Stars standards compliance
  • Utilize effective communication with internal customers/departments and external customers to accomplish accreditation and/or regulatory goals
  • Conduct departmental and file audits, as required, and prepare professional, timely audit reports/outcomes w/ meaningful recommendations for improvement provided
  • Assures policies/procedures compliance to regulatory and accreditation requirementsAssures and/or assesses Stars and HEDIS related interventions to assure rates improvements
  • Continuously identify streamlining opportunities r/t the regulatory and accreditation auditing processes to customer and organization-wide customer satisfaction
  • Assists with training, in-services and quality audits as a result of plan, regulatory or accreditation requirements
  • Assists with any/other project duties, as needed
  • Assists with accreditation related duties, as needed
  • Assists with HEDIS related duties, as needed
  • Attend MAC and PEM meetings, as needed
  • Maintains strict confidentiality
  • Maintains current knowledge of VPHP policies and procedures
  • Participates in continuing education activities, as appropriate
  • Other quality duties as assigned

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s Degree in Business, Public or Health Care Administration (preferred)

SPECIAL KNOWLEDGE AND/OR SKILLS

 

  • Proficient in the use of Microsoft Office Suite and database management
  • Proficient in the use of Microsoft Project or similar tool
  • Excellent verbal and written communication skills, plus strong organizational skills
  • Ability to plan, prioritize and multi-task  
  • Project management skills
  • Strong problem solving skills in a fast paced environment
  • Effective group facilitation abilities
  • Ability to interact with varying levels of staff
  • Ability to adapt to changing priorities
  • Demonstrate positive interpersonal skills
  • Must be able to travel 

WORK BACKGROUND/EXPERIENCE

  • Prior Star Ratings experience, especially related to ensuring compliance with state, federal and accreditation regulations and/or standards, clinical, and/or credentialing experience is highly preferred
  • Proven experience with standards interpretation and compliance preferred
  • Prior experience working in Healthcare or Managed Care

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

About Us

Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

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