Blue Cross of Idaho (BCI) has opportunity for a Director, Medicare STARS Program. The Director is accountable for achieving the highest possible Medicare STAR rating for all contracts through successful execution of business initiatives. This role sets the vision and creates the strategic direction for the STARS program working collaboratively with multiple business partners throughout the organization. The Director oversees the specific and tactical initiatives across multiple departments, designed to achieve and maintain the highest possible STAR rating. The work is carried out using high collaboration with multi-disciplinary teams, external vendors, providers, state and federal regulators. The Director will lead a small team of direct reports.
This position reports to the VP, Government and Commercial Business. Hybrid schedule is supported in a mutually acceptable location in Idaho. #LI-Hybrid
To be considered for this opportunity:
Experience: Ten (10) years relevant experience to include management, with at least 3 years as a subject matter expert in Centers for Medicare and Medicaid Services (CMS) STARS in all measurement categories.
Education: Bachelor's Degree or equivalent work experience (Two years' relevant work experience is equivalent to one-year college)
You will be an excellent fit for this position if you have:
Ability to lead, influence change, initiate and shape work with colleagues inside and outside the organization to achieve outcomes
Ability to develop and maintain effective working relationships at all levels
Proven track record in leading business initiatives to successful completion
Ability to present effectively to large and small audiences
Negotiation and contracting skills
Collaboration skills
Preferred Qualifications:
Extensive knowledge of CMS regulations and compliance expectations
Master's degree in Business or related field
Experience in a managed care environment, with leadership in a matrixed environment
Strong analytical background within Medicare Advantage plans
Here's what your day may look like:
Design, develop, and implement focused strategies for optimal stability in STARS achievement
Lead the development of the STARS program that are essential to the organization and ensure execution and performance of the program.
Provide advice and consultation to senior and executive management related to operational and/or strategic decisions and resolve critical issues
Provide corporate-wide subject matter expertise and champion of the STARS program and culture.
Responsible for comprehensive analysis and predictive analytics of STAR measures, barriers and opportunities
Develop continuous measurement models and actively inform key business partners of current measurements and opportunities
Synthesize performance status and communicate with leadership and business partners
Create the framework for data collection, data feeds, and evaluating data to improve performance of processes and outcomes
Prepares project documents in collaboration with operational leaders to gain support of business initiatives, including budget needs
Actively participate in the budget and goal setting process for the department
Monitor and update business rules for annual CMS STAR changes and educates internal partners
Represent BCI in the community, industry, conferences, and sales opportunities
Negotiate contracts with related vendors
Provide guidance, counseling, and continuing education opportunities to the team. Select, develop, coach, mentor, and assess performance of staff
Provide guidance to consistently improve the processes
Provides leadership through influencing and advising the work of others to implement plans to meet strategic and operations objectives
Perform other duties and responsibilities as assigned.
Reasonable accommodations
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.
