Job Information
Blue Cross and Blue Shield of Louisiana STAR Rating Improvement Director in Baton Rouge, Louisiana
We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.
POSITION PURPOSE
This position is responsible for the design, development, implementation, and evaluation of programs focused on improved CMS (Centers for Medicare & Medicaid Services) Part C and Part D Star Ratings. Responsible for Medicare Star projects and programs, this position will work with leadership and cross-functional and cross-divisional teams to support the design and execution required to advance organizational or divisional strategic priorities. The director will work to find resolution of complex business issues, identify business opportunities/requirements, and help the business effectively manage change. The position will be a part of program teams that cross the organization and manage through programs with tight deadlines. The position serves as the liaison between multiple departments within the organization.
NATURE AND SCOPE
This role does not manage people
This job reports to: VP, Health Services and External Leadership
Necessary Contacts: To fulfill this position, the incumbent must be in contact with Medicare Advantage leadership and management.
QUALIFICATIONS
Education
Bachelor’s degree in business, nursing, analytics, public health, health sciences, health promotion or related field required
Four years of related experience can be used in lieu of a bachelor’s degree
Work Experience
Minimum of 5 years of experience in government programs, value-based programs, quality improvement or similar role required.
Medicare Advantage, HEDIS, analytics, quality, or value-based program experience required.
Skills and Abilities
Demonstrated organizational relationship management skills.
Ability to thrive in ambiguity.
Strong critical thinking skills and problem solving/conflict resolution skills.
Attention to detail and time management skills.
Self-motivated, ability to work independently, and demonstrated ability to work under tight time frames.
Knowledge of the health care industry, payer business models, business segments and products.
Proven ability to handle various assignments in a fast-paced and complex business environment.
Proven ability to define problems, collect and analyze data, establish facts, and draw valid conclusions.
Excellent verbal and written communication skills and comfortable presenting to leadership.
Ability to navigate through multiple computer programs with ease including but not limited Microsoft Outlook, Teams, Word, Excel, Visio, and other corporate software programs and applications
Ability to work cohesively in a matrix organization and interact effectively with all levels of staff
Licenses and Certifications
- Lean Six Sigma preferred
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Effectively lead and partner with cross functional business units in planning and executing Stars improvement strategies and programs. Key functional areas supported include developing and executing new STARs performance improvements initiatives, managing, and standardizing existing Stars improvement projects, evaluating, and optimizing programs to deliver impact, and Stars reporting and compliance.
Develop strategic direction, training, goals, and coaching plans for Medicare Stars Team and cross-functional Teams supporting Stars programs.
Lead the strategy and tactical direction to improve member experience and provider HEDIS engagement
Drive the development and execution of high-priority Stars strategy initiatives critical to the company’s success of achieving top clinical outcomes and Star rating targets
Influence thought leadership regarding measure level improvement opportunities and serve as a subject matter expert in meetings and discussions.
Collaborate with cross-functional teams to assure regular tracking of Stars program KPIs to inform timely follow-up, escalation of gaps and barriers, and advancement of innovative workflows to support and promote quality improvement initiatives
Maintain effective documentation to meet regulatory and Accreditation Standards, as applicable.
Ensure that best practices are followed and develop innovative approaches in collaboration with internal and external stakeholders to improve member and provider engagement
Analyze and interpret data from multiple data sources to identify trends, evaluate efficacy, proactively solve complex problems, remediate risks, and develop plans to drive continuous improvement across HEDIS, CAHPS and Pharmacy measures.
Effectively lead cross functional teams to implement Medicare Stars measure level improvement interventions across all key categories of the Stars Program and partnering with both internal and external resources, including internal senior leadership.
Develop strong relationships with the Health Services team to be able to effectively communicate new requirements and opportunities around clinical workflow, data reporting, and support services to optimize quality outcomes, including incentive program results.
Work closely with data analysts to develop and manage targeting and monitoring capabilities
Develop content for leadership review, structure decks, prepare speakers, anticipate key issues and questions and data needed to drive productive discussion
Identify and articulate data needs required to assist with solving business problems; evaluate analytical outputs, testing relevance and applicability and identify key insights
Stay abreast of and keep the organization appraised of existing and new Federal/State issues impacting Star ratings; lead program updates as needed and incorporate into work programs and processes
Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities
Job duties are performed in a normal and clean office environment with normal noise levels
Work is predominately done while standing or sitting
The ability to comprehend, document, calculate, visualize, and analyze are required
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An Equal Opportunity Employer
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Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Insurance