As a Medicare/Stars Senior Consultant at ProspHire, you will help define and execute medium to large-scale enterprise initiatives that deliver quality outcomes for our clients. You will also assist with Firm operations and business development and help cultivate an inclusive culture founded on relationships and relentless dedication to client service.

The ideal candidate will have experience demonstrating strong project management, business process and technical skills. They will also have a strong background in HEDIS/Stars and experience leading a quality improvement program in accordance with the strategic goals of a health plan.

Requirements

·     Engage leadership on HEDIS/Stars strategy, make recommendations to address areas of concern and provide status on projected results

·       Collaborate with health plan leadership to develop processes to measure and collect data for HEDIS/Stars indicators

·       Partner with leadership to implement a quality improvement program in accordance with the strategic goals of a health plan; Analyze and identify trends to develop improvement strategies and action plans for quality rating systems (HEDIS, QRS, Stars) across all lines of business

·       Manage quality initiatives and work cross-functionally with clinical and technical teams to develop the tools, processes and reporting required to ensure compliance with a complete and accurate coding and billing function

·       Provide timely monitoring of HEDIS/Stars program data submissions: CAHPS, HOS, HEDIS, etc.

·       Establish and communicate protocols and standards of care for the Medicare Advantage, Medicaid and ACA member populations while providing intervention guidelines based on current population health needs

·       Establish professional relationships with vendor partners, regulators, internal stakeholders and community agencies to facilitate quality processes

·       Closely follow CMS guidelines and translate into business strategies and tactics

·       Develop an in-depth understanding of the client's business and make strong contributions to business development

·       Directly supervise, manage and mentor Firm team members on projects; Identify and resolve risks related to team and projects

·       Apply knowledge of organizational change management and design, development and implementation processes to deliver measurable, sustainable solutions

·       Help clients define success and establish metrics to track business objectives; Define the “as is” and “future state” of business, operations and technology issues

·       Critically evaluate information from multiple sources, reconcile conflicts and distinguish user requests from true underlying needs

·       Develop and manage a project plan; Identify tasks, define timing and manage resources accordingly

·       Summarize and deliver information to clients through documentation and presentations; Communicate status, issues and risks to high-level executives

·       Build and maintain personal and professional client relationships; Work well with different personalities

·       Create a positive work environment and foster open communication

Qualifications:

·       A bachelor’s degree in a relevant field

·       5+ years’ experience driving, managing and delivering medium to large-scale business solutions

·       Deep understanding of Medicare, Stars and HEDIS programs  

·       Authorization to work in the U.S.

·       Ability to travel up to 50% of the time, if necessary; Our Firm has national clients

Benefits

·       Competitive compensation, plus bonus

·       Medical, vision and dental

·       401k with 4% match

·       Flexible time off and paid holidays

·       Paid parental leave

·       $500 annual wellness subsidy

·       Modern and cool workspace in Downtown Pittsburgh

·       Snacks (of course)