Director, STARs

Director, STARs

Job Summary:

ArchWell Health's Director of STARs will be an integral part of the medical management team. The Director of STARs is responsible for operationalizing programs and driving market accountability of CMS STARs HEDIS measures, partnering with markets, payers, and the clinical quality team for strategy and data sharing. This role will interface with health plans, operational and clinical leaders, IT data engineering, vendors, and patient care teams. This role will provide leadership, design, and execution of Quality initiatives and workflows at ArchWell Health that improve value-based care over multiple markets and states in an outpatient senior-focused primary care setting.

Duties/Responsibilities:

• Demonstrate that AWH is a best-in-class senior focused medical group by demonstrating AWH practices in the markets they are in the top 75^th percentile or greater of medical groups. Drive continuous improvement and innovation to develop and maintain market-leading STARs performance.
• Ownership of enterprise STARs performance for all CMS STARS performance (Part C, Part D, CAHPS/HOS) ArchWell Health over multiple health plans and markets
• Ensure timely and complete submission of clinical information to minimize missing supplemental data. Manage supplemental data submission strategy, clinical documentation requirements, manual supplemental submission processes, automated supplemental submission processes, and a schedule of submission timelines.
• Partner with leadership to develop strategies, tactics, playbooks and education for all teams involved in driving STARs performance.
• Develop, monitor, and implement annual STARs work plans that drive a schedule of tactics to optimize STARs performance
• Cultivate a single system of records used across the enterprise to manage and track the status of all payor-reported quality gaps and workflows for pursuit, gap closure, abstracting, supplemental submission, and reconciliation between ArchWell gap closure status to Payor reported gap closure status.
• Develop reporting, goals (e.g. glidepaths), shared enterprise-wide workflow tools (e.g. trackers) used across market and central teams to track the disposition of all quality gaps (Part C, Part D, CAHPS/HOS) monitor outcomes leveraging quality trackers and glide paths
• Design and implement innovative enterprise and local strategies and initiatives for closing HEDIS gaps
• Accountable for the development and progress of supplemental Quality data submission
• Collaborate and support market clinical/operations team to achieve organizational outcomes
• Facilitate regular (weekly or daily when required) market level quality meetings
• Partner with market leadership as they facilitate, present and address STARs performance and progress on the annual work plan at Market Monthly Operating Review, serving as the Subject Matter Expert for STARs and overall accountable leader for enterprise STARs performance
• Meet regularly with health plan representatives
• Build relationships and collaborate with IT data team, Pharmacy team, and market leadership.

• Additional responsibilities and duties as requested and deemed necessary by the executive team and VP of Medical Management.

Required Skills/Abilities:

• Expert level knowledge of CMS STAR Measures
• Expert level knowledge of STARs documentation and supplemental data requirements and submission processes
• Experience with Electronic Medical Records
• Advanced knowledge of NCQA Technical Specifications
• Working knowledge of ICD-10, CPT, and HCPCS codes
• Proficient with Microsoft Office Suite products including Word, Excel, Power Point, and Outlook, and Teams

• Demonstrated strong leadership and team building skills
• Experience in clinical process improvement
• Excellent presentation, verbal, and written communication skills
• Ability to exercise the use of independent judgement
• Sensitivity to the diverse needs of culturally diverse staff, patients, and communities
• Experience in development and maintenance of guidelines and clinical policies

Minimum Qualifications:

• Bachelor's degree preferred; relevant experience will be considered in lieu of degree
• Minimum of 10 years' experience with the CMS STAR program operations, including at least 3 years in a leadership role required
• 5 years prior experience as the functional leader overseeing the entire STARs operations for a MAPD plan, complex full-risk medical group or medical network strongly preferredEmbodies and serves as a role model of ArchWell Health's Values:

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  • Be compassionate
  • Strive for excellence
  • Earn trust
  • Show respect
  • Stay resilient
  • Always do the right thing
  
  
  
  

About ArchWell Health:

At ArchWell Health, we're creating a community of caring designed to help our members stay healthy and engaged. By focusing on a strong provider-patient relationship, routine wellness, and staying active, our members enjoy a higher level of care and better quality of life after the age of 60. Everything we do is for seniors. We believe seniors should be heard, listened to, and given ample time by their physicians to live well later in life.

Our value-based care model is designed to prevent illnesses while keeping members healthy and happy in every aspect of their life. We deliver best-in-class primary care at comfortable, accessible neighborhood centers where older adults can feel at home and become part of a vibrant, wellness-focused community. We're passionate about caring for older adults and united by the belief that caring has the power to change everything for our members.

ArchWell Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to their race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other protected classification.