General Purpose: The individual holding this position is required to support and demonstrate their commitment to the Longevity Health Plan Statement of Purpose, which is: To improve the health and quality of life of nursing home residents by caring for their unique medical, social, and emotional needs.

The Director, Medicare Stars is responsible for oversight and leadership of all Medicare Stars related activities at LHP. The Director works closely with the Vice President of Clinical Quality, Clinical Leadership, Finance, Compliance, Operations and IT to identify and to implement strategies to assure compliance with performance improvement requirements set by the organization and by CMS. The Director will lead workgroups and projects designed to improve/maintain the Medicare Star ratings at LHP as well as our Partner quality metrics tied to Stars measures. The position requires someone with strong performance improvement and analytical capabilities, project/program management discipline, experience collaborating across teams, and a passion for improving the health and quality of life of nursing home residents.

 

Key Tasks and Responsibilities:

• Direct establishment and monitoring of Star measure related metrics and reporting scorecards to assess overall effectiveness and performance Plan Star ratings and IPA quality metrics related to Stars.
• Develop expert understanding of Star measures, ratings and methodology to inform strategic plan, set and drive the execution of work plan, initiatives, and overall Star performance. Lead and/or actively participate in provider meetings, workgroups, committees, etc.
• Subject Matter Expert on Star measures, past, current, and predicted performance and CMS changes to the Stars program and the impact of the changes on the Plan’s ratings.
• Create, drive implementation, and monitoring process of the Stars Program strategy, objectives, tactic, and initiatives to drive a year over year 4+ overall Star Ratings and meeting Program goals.
• Develop Star Rating performance improvement strategies for the company with specific goals for quality improvement in key areas.
• Collaborate with stakeholders to identify Star Rating program opportunities and evaluate program effectiveness.
• Maintain a clear & shared vision for Stars improvement efforts and track progress against well‐ defined program roadmap.
• Direct development of standard reports, tracking tools, metrics to monitor vendor performance, Stars/Quality measures, tactics, and initiatives.
• Partner closely with business leaders across the company to educate on and evangelize the importance of Medicare Stars and how their capabilities and continuously innovating to expand upon existing products, processes & operational experience impact Longevity Health Plan’s and our partners’ Star ratings.
• Lead Stars Steering Committee meetings.
• Lead cross functional efforts to develop, deploy and manage reporting dashboard.
• Performs other related duties as assigned.

 

Credentials & Coverage:

• Clinical License within home state.
• Valid state driver’s license with a good driving record and proof of automobile insurance required.
• Auto liability insurance coverage per minimum required by home state.

 

Education and Training:

• Bachelor’s degree in Business Administration, Healthcare Administration, Nursing, Medicine, or a comparable area of study required.
• Master’s degree in business administration, Healthcare Administration, Nursing, Medicine, or a comparable area of study preferred.

 

Knowledge and Experience:

• 7+ years of experience managing/ directing a managed care Medicare Stars program, 3 years needing to be with a Special Needs Plan.
• Strong knowledge and 7+ years of experience working with CMS Stars Ratings measures including HEDIS, CAHPS, PQA/Pharmacy, HOS, Operations, and CMS Display measures.
• Intermediate or higher level of proficiency with Microsoft Word, Excel, Outlook, and PowerPoint
• 7+ years of experience working in a team‐oriented, collaborative environment.
• Excellent verbal communication and interpersonal skills.
• Proven success on building and maintaining positive relationships.
• Ability to influence and persuade people to collaborate and execute toward a common goal.
• Strong organization and documentation, attention to details, ability to handle multiple projects and tasks simultaneously, time management meeting deadlines, even under pressure.
• Ability to think analytically to resolve issues; solution‐focused mindset; creative, innovative, and compliance thinker.
• Comprehensive understanding of performance improvement, quality assessment, regulatory and risk management, patient/member safety, and program management.
• Experience in achieving results and documented track record of implementing and accomplishing quality/safety improvements across inter‐disciplinary teams.

 

Company Overview:

Founded in 2018, Longevity Health started as an Institutional Special Needs Plan (ISNP), a type of Medicare Advantage health plan that addresses significant unmet needs of long-term institutionalized members who reside in nursing homes.  Through rapid growth from 2018 to 2022, we expanded our market footprint and currently offer ISNP Medicare Advantage plans in Colorado, Florida, Illinois, Michigan, New Jersey, New York, and North Carolina. 

In 2023, we expanded our service offerings to the broader health plan market.  In addition to our existing markets where we are both the ISNP and the care management team, we are now partnering with National Carriers on their offered ISNP plans in Ohio, Pennsylvania, upstate New York, Georgia, South Carolina, and Texas, with implementations in progress for several other additional US states. This allows us to utilize our core skills of supporting clinical post-acute needs of this vulnerable senior population Currently 13 markets and expanding rapidly.

 

Company Disclaimers:

Longevity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

It is the policy of Longevity Health to follow Federal and / or State regulations surrounding COVID vaccinations.  While CMS guidelines have been relaxed, there are some LHP facilities which will still require staff be vaccinated in an effort to protect the health of the members / patients we serve.  If your assigned location(s) require all staff to be fully vaccinated, you are required to obtain and / or provide documentation related to your COVID vaccination.  To confirm whether your assigned location(s) require COVID vaccinations, please refer to the Facility Guide Job Aid located on Longevity Health Plan’s intranet site. 

 

The Company will engage in an interactive process with individuals who cannot be vaccinated for medical or sincerely held religious beliefs to determine if a reasonable accommodation can be made. While an exemption/accommodation may be initially granted, if at any time during employment, it is determined that an exemption/accommodation that has been granted is no longer considered a reasonable accommodation, it can result in employment with the Company ending.

 

Candidates must meet the Company’s hiring criteria which include a pre-employment background and drug screening.

 

Longevity Health offers a competitive compensation and benefits package which includes medical, dental, vision, short and long-term disability, life insurance, and 401(k).

 

Submission of false information during the application process may result in immediate termination of employment without notice.