Quality Manager, Health Plan

Job Summary

Leading quality initiatives, the full-time Manager, Quality & Stars will oversee the CMS Medicare Star Ratings program and BadgerCare Pay-for-Performance, collaborating with internal teams and external partners to enhance health plan performance and member experience in a remote setting.

Key responsibilities

• Manage the end-to-end Stars Program, including analyzing regulatory guidance and implementing tactical work plans
• Collaborate with cross-functional teams to drive improvements in clinical care and maximize quality scores
• Educate the organization on the impacts of quality ratings and manage vendor relationships while mentoring team members

Required qualifications

• Bachelor's degree in business administration, healthcare administration, or a related field required; Master's degree preferred
• Five years of experience in managing quality or performance in the payor or provider space
• Demonstrated outcomes and knowledge of reporting and analysis of healthcare-related data
• Experience in project management within the healthcare industry
• Familiarity with health plan quality performance and ratings preferred