Resp & Qualifications
PURPOSE:
The Business Consultant (Stars Outcomes) provides expertise in tailored, strategic, and critical work to help design, launch, and execute programs that support Medicare Advantage Stars initiatives in the changing healthcare environment. The Business Consultant (Stars Outcomes) will be responsible for an assigned set of 8-10 Star measures and is responsible for driving enterprise performance to 4 Stars for each measure, working with cross-functionable accountable areas.
We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.
ESSENTIAL FUNCTIONS:
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Provide subject matter expertise in a Medicare Advantage Star Ratings that contributes to the effective accomplishment of initiatives tasks and goals:
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Leads governance and ownership for 8-10 assigned Star measures, managing 25-35 active interventions simultaneously.
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Develops and tracks detailed project plans, monitors progress, proactively removes barriers.
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Performance management including measure-level dashboards, identifying trends and risks, development of weekly executive level scorecards.
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Supports ongoing Stars strategy development.
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Develop presentations for committees, executive leadership, and stakeholders.
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Identify "data gaps in care" and work with analytics team partners to drive improvement in clinical measurement.
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Analyze member outreach performance across channels, including internal, vendor, and provider partners.
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Evaluate outreach effectiveness and make recommendations for improvement.
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Coordinate outreach efforts to minimize duplication and maximize gap closure.
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Work with provider relations and value-based care teams to improve provider engagement in Stars work, including closing gaps in care, improving electronic clinical data submission, and help drive achievement of provider quality incentives.
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Build trusted relationships within CareFirst to deepen subject-matter expertise, find opportunities to synchronize with core operations, and ensure close coordination with the central team in the execution of their areas of responsibility within the division.
QUALIFICATIONS:
Education Level: Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 5 years experience in business development, operational technology support, general business operations and/or consulting experience.
Knowledge, Skills and Abilities (KSAs)
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Expertise in Medicare Advantage Star Ratings and HEDIS
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Strong understanding of healthcare operations, Medicare Advantage, and member experience
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Understands business goals and priorities
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Follows evolving market, industry and consumer trends
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Effective communication of complex ideas both verbal and written
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Exceptional project management, facilitation and organizational skills
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Excellent relationship management skills
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Strategic thinker, problem solver, and a collaborator who can drive engagement and discussions
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Significant experience with MS Office (Excel, PowerPoint, Word)
Salary Range: $88,848 - $176,462
Salary Range Disclaimer
The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
PHYSICAL DEMANDS:
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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