Lead STAR Rating Improvement Analyst
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Job Description
Oversees healthcare quality improvement initiatives and manages Stars projects for Blue Cross. Collaborates with teams to enhance CMS Star Ratings and ensure effective outcomes.
Responsibilities:
- Oversee, plan, and implement new and existing healthcare quality improvement initiatives and educational programs that enhance CMS Part C and Part D Star Ratings.
- Manage enterprise‑wide Stars projects from design through completion, ensuring timely delivery and measurable outcomes.
- Serve as a key liaison supporting collaboration across multiple internal departments.
- Lead, plan, and execute Stars performance improvement initiatives across multiple business units.
- Manage and standardize Stars projects, ensuring effectiveness, compliance, and alignment with regulatory and accreditation standards.
- Analyze and interpret complex data sets to identify trends, evaluate program effectiveness, and develop improvement strategies.
- Serve as a subject matter expert, providing thought leadership on measure‑level improvement opportunities.
- Collaborate closely with cross‑functional teams to track KPIs, escalate barriers, and implement innovative quality improvement workflows.
- Build strong internal partnerships, particularly with Health Services and analytics teams, to support clinical workflow enhancements, reporting, and targeting strategies.
Requirements:
- Bachelor’s degree in business, nursing, analytics, public health, health sciences, health promotion, or related field required.
- 7 years’ experience in government programs, value‑based programs, quality improvement, or a similar role.
- Experience with Medicare Advantage, HEDIS, analytics, quality, or value‑based programs required.
- Strong organizational relationship management skills.
- Ability to thrive in ambiguity and operate independently.
- Critical thinking, problem‑solving, and conflict resolution skills.
- Excellent time management and attention to detail.
- Strong verbal and written communication skills; comfortable presenting to leadership.
- Ability to navigate multiple systems including Microsoft Outlook, Teams, Word, Excel, Visio, and other corporate applications.
- Ability to apply analytical and statistical knowledge to support quality improvement projects.
- Ability to work collaboratively in a matrix environment and engage effectively with all levels of staff.
- Knowledge of healthcare industry operations, payer business models, and quality programs.
- Lean Six Sigma certification preferred.
Benefits:
- health insurance
- retirement plans
- paid time off
- flexible work arrangements
- professional development
- bonuses
- stock options
- equipment allowances
- wellness programs
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