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Who we are:
Advantasure is a growing company and a member of the UST HealthProof family, Advantasure champions innovative solutions with an eye on the future-providing health plans with the flexibility to adapt to a changing regulatory environment and evolving business needs. Leveraging the industry’s leading experts in government-sponsored health plans, Advantasure offers solutions for administrative cost management, quality patient outcomes and experiences, enrollment growth, risk adjustment and quality and provider engagement initiatives.
We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States.
You Are:
The Manager, Quality Strategy is responsible to plan, organize, direct, control, and lead the assigned business unit. This position specializes in running the day-to-day operation for optimizing performance needed to achieve continuous improvement in Stars rating. The role performs within a matrixed, stakeholder partnership environment and should excel in driving synergistic strategies that drive end to end Stars and HEDIS improvement.
The Opportunity:
* To promote our mission of helping people live healthier lives, the Manager of Quality for HEDIS/Stars
* coordinates critical components of our quality management program in compliance with regulatory requirements and NCQA accreditation standards.
* Manager works within highly matrixed relationships to implement and maintain the core infrastructure of quality management program.
* Oversees the implementation of plan quality management components within the market for affiliates and employed medical groups.
* Proactively manages and responds to rapidly changing CMS requirements and environments.
* Collaborates across business segments to attain or maintain the plan’s compliance with CMS, NCQA, PQA standards and contractual requirements as they apply to the quality management program (HEDIS, Part D/Patient Safety, and Patient Experience)
* Develops and maintains positive relationships with health plan partners within the scope of the quality management program.
* Commands a comprehensive knowledge of risk arrangements, contracts, member, and provider benefit structure.
* Ensures the creation and submission of reports to meet health plan contractual requirements.
* Monitors HEDIS reporting requirements and annual reporting processes to confirm alignment with regulatory expectations and successful annual submission.
* Identifies gaps in patient care to better director provider and patient engagement for CMS Star Rating
* Prepares presentation and data for health plan and affiliate Joint Operating Committees and Provider education sessions.
* Develops strategies for quality improvement opportunities, including HEDIS and Part D/Patient Safety gap closure and patient experience.
* Maintains and develops strong collaborative relationships with payors, network providers/affiliates, vendors, and internal P3 Health Partner teams to ensure health data is accurate and complete and outcomes are met related to quality.
* Leads analytical and technical support for the development and data capture of Quality Measures
* Conducts in-depth analyses to target potential interventions or initiatives to improve health plan members quality of care and experience.
* Engages Network Providers, vendors, payers, and internal P3HP departments to educate, train, and achieve improved CMS Star Rating
* Tracks and reports KPIs and KAIs to achieve improved CMS Star Rating
* Other job duties as assigned.
What you need:
* Bachelor’s degree in healthcare related field, or comparable experience
* 3+ years of experience with demonstrated functional knowledge related to regulatory adherence of a quality management program (HEDIS, Part D/Patient Safety, NCQA, Stars, auditing, reporting, committee management)
* Experience leading Quality teams or similar supervisory experience.
* Experience making formal presentations in front of committees and work group environments and using virtual technology (e.g., Microsoft Teams/Zoom)
* Advanced level proficiency in software applications that include, but are not limited to, Microsoft Word, Excel, Outlook, PowerPoint
o CMS Saas and Power BI experience preferred.
* Proven solid written and oral communication skills with internal and external partners and employees.
* Effective project management skills in creating, evaluating, and improving strategies for project execution.
Five (5) years’ experience in related field with attention to preventative care within government funded health system programs and populations. Three (3+) years supervisory or lead experience in related field required. Bilingual skills preferred.
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 applicable law, UST provides a reasonable range of compensation for roles that may be hired in various U.S. markets as set forth below.
Role Location: Remote
Compensation Range: $98,400 – $142,700
What we believe:
We’re proud to embrace the same values that have shaped UST and its subsidiaries 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 place people at the center 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 honor 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.
UST Global celebrates diversity and inclusion. We are an Equal Employment Opportunity employer. We welcome candidates to apply for employment from diverse backgrounds and believe your unique perspective adds to the richness of our company culture. We do not discriminate based upon race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.
