Managing Director, Stars and HEDIS Quality Program Operations - Advantasure

Job Description

Advantasure is a growing company and a member of the UST HealthProof family, Advantasure champions innovative solutions with an eye on the future—providing health plans with the flexibility to adapt to a changing regulatory environment and evolving business needs. Leveraging the industry’s leading experts in government-sponsored health plans, Advantasure offers solutions for administrative cost management, quality patient outcomes and experiences, enrollment growth, risk adjustment, and quality and provider engagement initiatives.

We achieve this mission together through teamwork, communication, collaboration, and focus. Our employees are our greatest assets, and we invite you to apply to be a part of our journey toward making a difference in healthcare in the United States.

Visit us at UST.com **

You Are**

This role is responsible for planning, organizing, directing, controlling, and leading multiple business units. This role will set the vision and identify strategic direction for the Stars and HEDIS operations business units across clients. This role will support corporate goals and objectives and direct activities of multiple functional areas, including but not limited to planning, staff development, problem-solving, and communications. This role will establish the business unit’s goals and objectives that support continuous quality improvement, manage, and develop business unit leadership, and provide effective/efficient solutions to complex business problems. This role provides high-level oversight and leadership to the business unit and leads change effectively. **

The Opportunity**

• Responsible for formulating large-scale, current, and multi-year plan strategy development in a dynamic and evolving environment.
• Drive operational excellence, implementing and optimizing processes to maximize return on investment
• Ability to establish strong client relationships
• Execute and continuously improve end-to-end process model operations.
• Construct and execute data-driven performance management of processes, programs, vendors, staff, and providers. Conduct operations in a planned, metric-driven approach.
• Provide vision, leadership, planning, project coordination, and management for the development of a cost-effective department while concurrently facilitating efficient operations to meet current and future business needs within the organization.
• Represent the company in community and industry, programs, conferences, and sales opportunities.
• Prepare and deliver comprehensive updates, reports, and presentations to executive leadership, providing clear insights into key performance metrics, and business objectives.
• Partner and guide clients and key customer contacts through a continued process improvement effort to better engage members and providers in the Quality space
• Upon request, function as the department head in the absence of the Executive of the area.
• Champion innovation and adaptation, proactively identifying opportunities for business development and expansion while mitigating risk
• Participate in the development of programs as a strategic partner that supports the company plan.
• Participate in the development of the annual departmental budget, monitor budget, and identify budget discrepancies. Research cause and make recommendations.
• Responsibility for balancing workload to optimize the effectiveness of the department.

Directly supervises exempt and non-exempt staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include but are not limited to effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.

_This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required

_ What You Need

Bachelor’s degree in a related field along with advanced industry experience. Master’s degree in business, finance, or related field preferred. Continuous learning, as defined by THE COMPANY’s learning philosophy, is required. Certification or progress toward certification is highly preferred and encouraged.

• Eight (8) years of progressively more responsible experience in a healthcare environment with demonstrated technical experience that provides the necessary knowledge, skills, and abilities.
• years of experience in Stars or HEDIS including leadership experience developing and implementing new programs for Medicare Advantage or Medicaid products.
• 8 years of leadership experience in healthcare management is required.
• Proven ability to manage budgets, allocate resources effectively, and deliver sustainable ROI
• Experience leading teams through periods of transformation and growth is a plus
• Proven track record of strategic leadership, with a deep understanding of market dynamics and business drivers

Specific Skills Required To Be Successful In This Role

• Knowledge of Center of Medicare & Medicaid Services (CMS) rules and regulations related to Medicare and Medicaid) programs.
• Knowledge of Medicare Advantage, operating requirements and processes, and compliance expectations, along with the ability to coordinate Stars and HEDIS with risk identification and risk mitigation programs.
• Must have strong strategic orientation skills and demonstrated success continuously assessing market dynamics, competitive landscaping, and emerging trends to make informed decisions.
• Excellent analytical, organizational, and problem-resolution skills with the ability to present to both large and small audiences effectively.
• Exceptional communication and interpersonal skills, with the ability to inspire and motivate teams towards common goals.
• Ability to identify client opportunities and drive outcomes across opportunities whether it be internally or externally with the client
• Ability to establish cross-functional workgroups to drive performance improvements and outcomes
• Ability and proficiency in the use of computers and company standard software.
• Must demonstrate leadership ability and team-building skills to effectively supervise professional and non-professional staff and interact with all levels of management.
• Ability to work with and empower others on a collaborative basis to ensure the success of the unit team.
• Ability to effectively exchange information, in verbal or written form, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques.
• Ability to effectively present budgetary and/or cost information and respond to questions as appropriate.
• Ability to establish workflows, manage multiple projects, and meet necessary deadlines.

_Compensation can differ depending on factors including but not limited to the specific office location, role, skill set, education, and level of experience. As required by local law, UST provides a reasonable range of compensation for roles that may be hired in California, Colorado, New York City, or Washington as set forth below.

_ Role Location: Remote

Compensation Range: $156,000 - $227,000 **

What We Believe

**_We’re proud to embrace the same values that have shaped UST since the beginning. Since day one, we’ve been building enduring relationships and a culture of integrity. And today, it's those same values that are inspiring us to encourage innovation from everyone to champion diversity and inclusion and to place people at the centre of everything we do.

_ _Humility: We will listen, learn, be empathetic, and help selflessly in our interactions with everyone.

_ _Humanity: Through business, we will better the lives of those less fortunate than ourselves.

_ _Integrity: We honor our commitments and act with responsibility in all our relationships.

_ _**Equal Employment Opportunity Statement

**_ _UST is an Equal Opportunity Employer.

_ _All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

_ UST reserves the right to periodically redefine your roles and responsibilities based on the requirements of the organization and/or your performance.