Officer, Medicare STARS

Reporting to the Chief Medical Officer, the Officer, Medicare STARS (STARS Leader) oversees health plan strategy and achieving SFHP's performance goals for the Part C and D Medicare STARS programs for all Medicare products (currently D-SNP) and related programs that influence STARS rating. You will design and implement Medicare STARS strategies across the organization to achieve improvements in the Plan's CMS STAR Ratings measures. You are responsible for SFHP's CMS STAR ratings performance to be at least 4 STARS on a continuous basis. You will develop working relationships with partners across the organization, contracted vendors, and our Provider Network and Health Services team to ensure optimal STAR Ratings are achieved and maintained. You have ownership for driving STARS improvement strategy and outcomes with teams across teams at SFHP to ensure the advancement of Medicare STARS Program priorities. Your role will involve a blend of strategic planning, performance monitoring, stakeholder engagement and regulatory compliance to enhance the plan's STARS ratings.

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

Salary: $245,000 to $275,000 Annual

WHAT YOU WILL DO:

• Plan, develop, and implement improvement strategies to achieve top scores for Medicare Part C and D STARS.
• Develop strategic direction, objectives, training, goals, performance targets and development plans for Medicare STARS Team and cross-functional SFHP Teams supporting STARS programs.
• Lead and implement Medicare STARS-related measure performance analytics with an aim to identify areas of opportunity, key drivers, and impact assessment on quality improvement related activities to impact measure performance, including HEDIS, CAHPS, HOS and other quality measures to assess progress.
• Ensure that the STARS program complies with CMS guidelines, quality standard and reporting requirements.
• Develop relationships with the SFHP Provider Network team to communicate new requirements and opportunities around clinical workflow, data reporting, and support services to optimize quality outcomes, including SFHP Pay for Performance results.
• Lead direct reports to meet organizational goals; develop and implement strategies to manage the team and its development.
• Drive and partner with cross functional business units in planning and executing STARS improvement strategies and programs. Key functional areas supported include developing new STARS performance improvement initiatives, managing, and standardizing existing STARS improvement projects, evaluating and optimizing programs to bring impact, and STARS reporting and compliance.
• Collaborate with internal partners to design and implement quality improvement and member satisfaction initiatives.

WHAT YOU WILL BRING:

• 10 or more years of current progressive, operational experience in a health plan or managed care setting with a focus on excellent process and execution.
• Expert knowledge of the principles and practices of Medicare STAR rating.
• Prior Experience driving and leading at least a 4-STAR Medicare or Medicare Advantage STARS Rating. Specific rollout and implementation experience achieving at least a 4 STAR rating for Medicare STARS or Medicare Advantage in a non-integrated healthcare setting consisting of diverse provider types, including solo, small and medium size practices, and IPA's.
• 5 years of strong senior level leadership/management experience
• Bachelor's degree in public health, business, or other related fields from an accredited institution. Master's degree or higher in healthcare administration, nursing, hospital administration, business, public health, or related field from an accredited institution preferred.
• Experience in clinical data analysis and trending.
• Experience with Health Plan Part C requirements: staying health equity index, healthy measures, managing chronic long-term conditions, member experience, member complaints, and customer service.
• Experience with Health Plan Part D requirements: drug plan customer service, member complaints, member experience, and drug safety and accuracy of drug pricing.
• Specific operational understanding of the differences in achieving a 4-STAR rating in an integrated vs. a non-integrated healthcare system.
• Experience in current regulatory requirements for Part C/Part D measures.
• Experience in CAHPS, member experience, health equity index (HEI) and access measure performance.
• In-depth knowledge of coding and documentation training programs for the provider network to support Medicare STAR measure performance.
• In-depth knowledge of supporting finance teams in the improved coding accuracy and improvement in the year-over-year Risk Adjustment Factor associated with the attributed population, with an understanding of fee for service and capitation.

WHAT WE OFFER:

• Health Benefits
  
  
  
  • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
  • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
  
  
  
  
• Retirement - Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off - 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

ABOUT SFHP:

Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.

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