Medicare Star Ratings Consultant

HealthPartners is currently hiring for a Medicare Star Ratings Consultant. The consultant leads the design and execution of enterprise-wide Medicare Stars strategies to elevate our health plan product's CMS Star Ratings. With a primary focus on survey-based CAHPS and Health outcomes measures, the consultant also supports the broader Stars program through expert guidance and cross-functional collaboration.

Key responsibilities include monitoring member experience indicators, identifying actionable opportunities for improvement, and leading initiatives that enhance Medicare member satisfaction. The consultant will collaborate closely with internal teams, external partners like providers, and vendors to align efforts and achieve shared goals. Staying informed on industry trends and regulatory changes is essential to ensure timely, accurate insights and recommendations.

Required Qualifications:

• Bachelor's degree in business, health care administration, health policy or other relevant discipline or equivalent years of related work experience.
• Four (4) years of professional experience in a health plan or managed care setting, with relevant work in Medicare Advantage or other Medicare products.
• Two (2) years of experience with Medicare Star ratings or other similar quality improvement framework.
• Proven history of building and sustaining collaborative relationships across all levels of an organization, including senior leadership and cross-functional teams.
• Experience coordinating and managing multiple projects and initiatives simultaneously
• Demonstrated ability to build, lead and direct cross-functional teams through a strategic planning process to meet business goals.
• In-depth knowledge of Medicare products, regulations, and/or star ratings.
• Excellent communication, facilitation, and presentation skills.
• Ability to navigate ambiguity in a complex and matrixed environment.
• Strategic critical thinking skills, with a high level of curiosity and openness to change.
• Proven leadership ability is exemplified by a capacity to think strategically and implement tactically to consistently deliver results, well-developed skills in diplomacy and collaboration.
• Knowledge of computers including Microsoft Office (Word, Excel, PowerPoint, SharePoint) and reporting, database, analytics applications.
• Strong analytical skills.

Preferred Qualifications:

• Three (3) years of Medicare Stars CAHPS, HOS, HEDIS or similar experience
• One (1) year of experience collaborating with provider quality improvement on behalf of a managed care organization.
• Experience with analytics in a healthcare setting

Hours/Location:

• Monday - Friday; core business hours
• This position offers remote work flexibility but requires onsite presence for occasional meetings or workgroup sessions, typically averaging once per month.

Responsibilities:

• (50%) Monitor member experience indicators and identify opportunities for improvement.
  • Serves as the stars subject matter expert on Medicare CAHPS performance indicators and trends.
  • Leads the development of data collection and reporting methods to monitor member experience and Medicare CAHPS performance.
  • Monitors and analyzes member experience indicators and Medicare CAHPS outcomes to ensure goals, objectives, outcomes are met.
  • Monitors for adverse trends, performs root cause analysis, recommends process improvement modifications and corrective actions.
  • Works within plan, care group, providers, and vendors to review best practices, programs, and processes for improvement opportunities. Responsible for bringing forward recommendations to the Stars leadership team.
• (50%) Acts as the lead of Medicare member experience initiatives. Collaborate with cross-departmental business leaders, external partners, and vendors to achieve common goals.
  • Provides Medicare CAHPS education and to the whole organization and external partners.
  • Provides Medicare CAHPS performance reporting to all levels of staff including executive leadership.
  • Leads and/or participate in internal and external activities, workgroups, meetings, etc. that support Medicare CAHPS performance.
  • Develop strong business partnerships with key areas throughout the organization and external partners to continually improve Medicare CAHPS performance.
• Perform other duties assigned to ensure business needs are met.

*Job description rankings/percentages are intended to reflect normal averages over an extended period of time and are subject to daily variances. Quality and efficiency standards should at no time be compromised to meet the average.