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 Clinical Strategy and STARS Lead - Wauwatosa, WI - MILWAUKEE, Wisconsin, United States

Job information
Posted by: UnitedHealth Group 
Hiring entity type: Insurance 
Work authorization: Not Specified for United States
Position type: Direct Hire, Full-Time 
Compensation: ******
Benefits: See below
Relocation: Not specified 
Position functions: Finance
Management - General
Operations - Other
Travel: Unspecified 
Accept candidates: from anywhere 
Languages: English - Fluent
Spanish - Fluent
Minimum education: See below 
Minimum years experience: See below 
Resumes accepted in: English
Cover letter: No cover letter requested
Job code: 811425_1 / Latpro-3669537 
Date posted: Mar-06-2019
State, Zip: Wisconsin, 53201


For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)

Are you a leader and subject matter expert in STARs, scope definition, risk identification, methodology and resource allocation or facilitation? Lead strategic initiatives crossing business teams and operating groups as a Star Lead to coordinate and complete projects, define performance, root cause analysis, develop and execute strategies, and innovate and drive local initiatives. STARs Lead will determine time frames, procedures for accomplishing project, and lead others in the organization to make meaningful process improvements. Assess, develop, coordinate, and implement strategies to align with national Stars quality activities. Assess provider network incentive status, data acquisition mechanisms and drive provider oversight towards gap closures and participate in HEDIS data collection.

If you are located in Wauwatosa, WI, you will have the flexibility to telecommute* as you take on some tough challenges. Position required intermittent travel to the Wauwatosa, WI office but can work remotely from home outside of that travel

Primary Responsibilities:

  • Monitor STARs measures and drive company performance measures

  • Monitor and evaluate all initiatives impacting population and adjust strategy as needed in consultation with National STARs team, Medicare & Retirement, and Member Navigation Team to determine mix of channels and delivery systems to drive 5 STAR ratings

  • Collaborate with Medicare & Retirement STAR activities to ensure cohesive and streamlined initiatives are developed, implemented, and tracked

  • Track and monitor Health Plans specific STAR ratings and how it relates to the overall contract performance

  • Perform root cause analysis for poor performance on administrative and clinical measures

  • Coordinate within the plan and cross functional areas to resolve and/or improve STAR and HEDIS measures

  • Develop and execute overall STARS strategy/initiatives in collaboration with health plan leadership, Medicare & Retirement, and National STARS team

  • Identify and drive Health Plan local strategy/initiatives to close STAR gaps

  • Support relationships with Health Plan providers to drive STAR ratings and identify new local opportunities for improvements

  • Innovate and drive local initiatives that address low performing measures

  • Coordinate and collaborate with local plan personnel, functional areas, Medicare & Retirement, and National STARs team to reduce/prevent complaints to Medicare (CTM) and develop corresponding mitigation action plans

  • Collaborate with local plan personnel and other functional areas to develop CAHPS interventions and Disenrollment Reduction Initiatives

  • Responsible for NCQA Accreditation oversight inclusive of meeting requirements, Trilogy documents and process oversight

  • DSNP HEDIS project lead with QSD Team and management of projects.

  • Track and trend all member and provider incentive programs offered in WI

  • Manage the STARS playbook designated by Medicare and prepare reporting as applicable to both contract requests

Required Qualifications:

  • Undergraduate degree or equivalent experience
  • 3+ years of STARs/HEDIS experience in healthcare
  • 5+ years’ experience in developing reports, working with large data sets and making data-driven analytical decisions
  • Intermediate level of proficiency with MS Project, Excel, and PowerPoint

Preferred Qualifications:

  • Proficiency with Tableau
  • 3+ years’ experience with successfully leading a cross functional team
  • Demonstrated ability to focus activities toward a strategic direction and achieve targets and meet deadlines
  • Proven track record of reaching and/or exceeding performance improvement plans
  • Experience acting as a liaison between business, clinical and technical teams
  • UnitedHealth Group, Optum, or UnitedHealthcare experience
  • Six Sigma / Lean certification or equivalent experience
  • Demonstrated ability to communicate ideas clearly and concisely
  • Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities
  • Bilingual (English / Spanish)

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.SM

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: STARS, HEDIS, Clinical Project Management, RN, LPN, Managed Care, Data Analytics, Clinical Strategy, Milwaukee, Shorewood, Glendale, Brookfield, Menomonie Falls, West Allis, WI, Wisconsin


Please see job description.


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