Medicare STARS LeadPrimary Location: Blue Bell, Pennsylvania
Additional Locations: PA-Blue Bell, PA-Harrisburg, PA-Philadelphia, PA-Pittsburgh, WV-Charleston Apply
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
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
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
Candidate must live in the Philadelphia, Harrisburg, Pittsburgh or Charleston WV metros
ADDITIONAL JOB INFORMATION
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.
58828Potential Telework Position: Yes Percent of Travel Required: 25 - 50%
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