STARS Quality Specialist

Site: Mass General Brigham Health Plan Holding Company Inc.

Mass General Brigham relies on a wide range of professionals including doctors nurses business people tech experts researchers and systems analysts to advance our mission. As a not-for-profit we support patient care research teaching and community service striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Job Summary

Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham we are on the forefront of transformation with one of the worlds leading integrated healthcare systems. Together we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.

Our work centers on creating an exceptional member experience a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today our employees have opportunities to learn and contribute expertise.

We are pleased to offer competitive salaries and a benefits package with flexible work options career growth opportunities and much more.

The Quality STARS Specialist supports a clinical health plans CMS Star Ratings performance by monitoring quality measures and translating data into actionable insights that improve care delivery member experience and outcomes. Partners with clinical quality pharmacy provider and operational teams to identify performance gaps support outreach and care gap closure initiatives and track progress across HEDIS CAHPS HOS and related measures. Serving as a subject matter expert in Star Ratings methodology and analytics supports regulatory compliance audit readiness program coordination and process improvement to strengthen quality performance and operational effectiveness.

Principal Duties and Responsibilities:
Data Monitoring and Reporting
oTrack performance on CMS Star Ratings measures across HEDIS CAHPS
HOS pharmacy and operational metrics.
oPrepare routine and ad hoc reports for leadership quality teams and
operational partners.
oIdentify performance gaps using data analysis and recommend targeted
interventions.
oMaintain dashboards scorecards and measure level documentation.
oA subject matter expert for the STARS analytics tool

Quality Improvement Support
oAssist in developing and executing quality improvement initiatives to raise
Star Ratings.
oSupport provider and member outreach campaigns aimed at closing care
gaps.
oCoordinate with clinical teams to ensure timely completion of preventive
screenings chronic condition management and medication adherence
activities.
oMonitor progress of interventions and escalate issues when performance
lags.

Cross-Functional Collaboration
oWork closely with departments such as Quality Clinical Operations
Member Experience Provider Relations Pharmacy and IT.
oSupport provider engagement efforts including distributing measure
education performance summaries and best practices.
oParticipate in internal workgroups focused on improving specific STARS
measures.

Regulatory & Compliance Support
oStay current on CMS Star Ratings methodology technical specifications
and regulatory updates.
oEnsure internal processes align with CMS requirements and audit
expectations.
oAssist with documentation for audits mock audits and compliance
reviews.

Program Coordination & Administration
oManage timelines deliverables and project tracking for STARS initiatives.
oSupport vendor coordination including data exchange reporting and
performance monitoring.
oMaintain organized records of program activities interventions and
outcomes.
oAssist with annual planning for STARS strategy and operational execution.
oHelp design and execute outreach campaigns to improve member
experience and close gaps in care.
oSupport provider education on measure requirements coding accuracy and documentation standards.
oCoordinate distribution of materials toolkits and communications.
Process Improvement
oIdentify workflow inefficiencies and recommend enhancements to improve
measure performance.
oSupport implementation of new tools processes or technologies that
streamline STARS operations.
oDocument standard operating procedures (SOPs) and maintain process
guides.
oBreaks complex topics into meaningful chunks of information.
oSeeks out multiple sources to gather information.

Education

• Bachelors Degree required (experience can be substituted in lieu of degree); Masters Degree preferred

Experience

• At least 2-3 years of experience in a CMS STARs role specializing in STARs program execution required
• At least 2-3 years experience managing STARs data data validation and outcomes required.
• At least 5-7 years in health plan quality in a managed care organization highly preferred
• Experience in healthcare quality STARs initiatives population health or related program coordination highly preferred
• Familiarity with QI methodologies and regulatory standards highly preferred
• Experience working with diverse communities or in community health managed care or hospital quality departments preferred
• Experience with SDOH screening tools community partnerships or health literacy initiatives preferred
• Certification in healthcare quality or equity (e.g. CPHQ CPHE Lean Six Sigma) preferred

Knowledge Skills and Abilities

• In-depth knowledge of healthcare regulations accreditation standards STARs program and quality improvement methodologies.
• Strong understanding of document management systems (DMS) such as SharePoint OpenText or Documentum to manage digital files track revisions and maintain version control.
• Familiarity with cloud storage systems and collaboration tools like Google Drive Dropbox and Microsoft OneDrive.
• Experience with electronic records management (ERM) and data retention policies.
• Demonstrates awareness of importance of security scalability reliability and feasibility in solutions
• Seeks out information to better understand impacts of design and implementation of systems
• Evaluates service areas to identify opportunities for automation
• Ability to draft revise and implement company policies and standard operating procedures.
• Knowledge of compliance standards including industry-specific regulations (e.g. healthcare HIPAA regulations financial regulations state and federal rules).
• Strong organizational skills to ensure policies and documents are properly filed categorized and easy to access.
• Ability to spot discrepancies or issues in documents and ensure compliance with required guidelines.
• Understanding of legal and regulatory requirements for document retention and management including data privacy and security laws.
• Knowledge of audit procedures and the ability to prepare documentation for audits.
• Excellent written and verbal communication skills for drafting policies and procedures as well as providing guidance to employees about document handling and compliance.
• Ability to train staff on document management practices and policy changes.
• Experience using document management software and workflow tools to streamline document processes and improve efficiency.
• Proficiency in Microsoft Office Suite (Word Excel PowerPoint Outlook) and other productivity tools is often required.
• Familiarity with document control software for versioning workflow management and access permissions.
• Ability to manage multiple tasks or projects simultaneously adhering to deadlines and ensuring that policies and documents are up to date.
• Experience with project management software such as Trello or Microsoft Project is beneficial.
• Ability to identify issues with document flow retention or compliance and propose solutions to resolve them.
• Strong critical thinking skills for analyzing policies and procedures to ensure they align with organizational goals and legal requirements.
• Excellent interpersonal skills including the ability to influence others at all levels of an organization.

Working Conditions

• This is a remote role that can be done from most US states

Remote

399 Revolution Drive

40

Regular

Day (United States of America)

Pay Range

$63648.00 - $90750.40/Annual

Grade

6

At Mass General Brigham we believe in recognizing and rewarding the unique value each team member brings to our organization. Our approach to determining base pay is comprehensive and any offer extended will take into account your skills relevant experience if applicable education certifications and other essential factors. The base pay information provided offers an estimate based on the minimum job qualifications; however it does not encompass all elements contributing to your total compensation addition to competitive base pay we offer comprehensive benefits career advancement opportunities differentials premiums and bonuses as applicable and recognition programs designed to celebrate your contributions and support your professional growth. We invite you to apply and our Talent Acquisition team will provide an overview of your potential compensation and benefits package.

8925 Mass General Brigham Health Plan Holding Company Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religious creed national origin sex age gender identity disability sexual orientation military service genetic information and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process to perform essential job functions and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973 the Vietnam Veterans Readjustment Act of 1974 and Title I of the Americans with Disabilities Act of 1990 applicants who require accommodation in the job application process may contact Human Resources at .

Mass General Brigham Competency Framework