Director, CAHPS and HOS Strategy and Execution

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Job Responsibilities:

• Translate enterprise-wide CAHPS/HOS strategies, developed through cross-functional executive collaboration, into detailed operational roadmaps; own the project lifecycle for all member experience initiatives to ensure 5-Star performance.
• Direct the annual refresh, maintenance and field implementation of the Provider Playbook. Ensure specific interventions for CMS Access to Care domain (i.e., getting needed care, getting care quickly, care coordination, rating of healthcare quality and getting needed prescription drugs) are being executed at the clinic and group level.
• Analyze CAHPS and HOS data and performance metrics to identify trends, opportunities for improvement, and develop action plans in partnership with operational leaders and network providers.
• Maintain a consistent field presence (60%+) to conduct in-person provider performance reviews and ensure onsite strategy implementation is meeting established KPIs for interventions directly mapped to CMS CAHPS and HOS domains.
• Leverage provider partnerships and high impact providers to drive member experience improvement.
• Implement and monitor provider incentive programs, ensuring financial levers are directly aligned with measurable improvements in CAHPS and HOS results. Share feedback from the field as to impact of incentives and performance across CAHPS and HOS results.
• Collaborate with cross-functional teams including Stars, Member Services, Member Retention, Network Management and Quality to improve touchpoints impacting member satisfaction.
• Serve as subject matter expert on CAHPS/HOS survey methodologies and regulatory changes, ensuring compliance with CMS guidance at all times to support provider groups.
• Prepare succinct, performance-focused updates for senior leadership, memorializing accountability for performance fluctuations and highlighting ROI on specific interventions.
• Promote a culture focused on service excellence, empathy, and continuous improvement.
• Other duties and projects not listed above

Supervisory Responsibilities:  

Oversees assigned staff. Responsibilities include: recruiting, selecting, orienting, and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and performance management.

Job Requirements:

Experience:

Required:

• 10+ years of progressive leadership experience in healthcare quality, member experience, and provider performance improvement.
• Experience working in health plans, provider organizations, or quality-focused healthcare settings.
• A proven track record of moving CAHPS/HOS metrics within a Medicare Advantage environment.
• Hands-on experience in driving provider engagement with demonstrated results in CAHPS and HOS performance improvement
• Working knowledge of provider contracting, with a focus on integrating Quality/Stars components into agreements to optimize CAHPS and HOS performance outcomes.

Education:

Required: Bachelor’s degree in Public Health, Healthcare Administration, Business, or related field

Preferred: Master’s degree preferred

Specialized Skills:

Required:

• Deep understanding of CAHPS and HOS methodologies, CMS Star Ratings, and quality improvement frameworks.
• Proven ability to lead cross-functional initiatives and deliver measurable improvements in member experience.
• Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors;
• Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly
• Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution.
• Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment.
• Report Analysis Skills: Comprehend and analyze statistical reports.

Other:

• Requires consistent field presence (minimum 60%) to conduct in-person provider engagements, provider performance reviews, and onsite strategy implementation.
• Serve as an internal expert on CAHPS and HOS survey methodology, regulatory changes, and CMS guidance
• Must demonstrate executive autonomy; able to execute enterprise CAHPS and HOS strategy with minimal supervision and communicate complex data insights to executive leadership.

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.