Skip to main content

A new day in healthcare. Together, CVS Health and Aetna help people on their path to better health.

Medicare STARS Lead

Primary Location: Blue Bell, Pennsylvania
Additional Locations: PA-Blue Bell, PA-Harrisburg, PA-Philadelphia, PA-Pittsburgh, WV-Charleston
Local quarterback with dual responsibilities in maintaining/improving market Stars ratings and risk adjustment; executes on STARS strategy as (local) extension to Segment best practices / resources

Fundamental Components:
Works across local market leadership to establish and champion for a local market culture committed to STARS and RAR excellence
Focused on quality, executing on national initiatives at local level
Identifyand develop local market STARS and quality strategies; manage local quality programs (e.g., PEP)
Monitor and trend member complaints, grievances and appeals in the local market and support local activities to mitigate issues
Manage and direct local vendors
Ensure compliance across various elements to minimize risk
Conduct data analysis, in conjunction with national tools, to identify opportunity areas and paths on track; assure member metrics being met
Identify which VBCs/non-VBCs to prioritize with HEDIS and RA initiatives
Produce content for training tools for agents developed around market needs (CTM drivers, RAF trends)
Engage with clinical team and specific clinics, medical groups, hospitals; attends JOM meetings; Supports engagement managers and RN program managers
Support local market colleagues in ensuring strategic and optimal bids; attends/hosts trainings
Additional dock-in points needed to manage include MSO, product, sales, network, performance, MEU

Health insurance / managed care
Quality standards principles, including Stars, HEDIIS, MRA
Ability to foster trust/relationships with key provider groups
Strong data and financial analysis acumen
Supervisory experience
Ability to execute strategy and devise plans

The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

Functional - Quality Management/Quality Management/1-3 Years

Telework Specifications:
Candidate must live in the Philadelphia, Harrisburg, Pittsburgh or Charleston WV metros

Key quality improvement role in Aetna's largest Medicare market with both local and national CMS contracts with performance as high as 4.5 STARS

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Potential Telework Position:

Percent of Travel Required:
25 - 50%

Click To Review Our Benefits (PDF)


Jobs for you

Recently Viewed Jobs

You do not have any recently viewed jobs

Your Saved Jobs

You do not have any saved jobs

Sign up for Job Alerts

Join our Talent Community

At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.

Join Our Talent Community

Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.