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Stars/RAF Lead

Primary Location: Chicago, Illinois
Additional Locations: IL-Chicago
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Description:
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 (Risk
Adjusted Revenue) excellence
· Focused on quality, executing on national
initiatives at local level
· Conduct data analysis, in conjunction with
national tools, to identify opportunity areas and paths on track; assure member
metrics being met
· Identify and 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
· Identify which VBCs/non-VBCs to prioritize with
HEDIS and Risk Adjustment 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 JOC 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


Background Experience:
3+ years of Medicare
Advantage experience with heavy focus in STARS/Risk Adjustment areas
Strong data and
financial analysis acumen
Fluent in Quality
standard principles
Ability to foster
trust/relationships with internal partners and key provider groups
Ability to execute
strategy and devise plans



Required Skills:
Leadership - Collaborating for Results, Leadership - Driving a Culture of Compliance, General Business - Consulting for Solutions, General Business - Turning Data into Information, General Business - Communicating for Impact

Functional Skills:
Products-Medical - Individual Medicare Advantage Plan, Quality Management - Quality Management

Potential Telework Position:
Yes

Percent of Travel Required:
25 - 50%

EEO Statement:
Aetna is an Equal Opportunity, Affirmative Action Employer

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

Candidate Privacy Information:
Aetna takes our candidate'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

Click To Review Our Benefits (PDF)

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