Regional Director of Medicare STARs - Telecommute in Seattle, WA

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

The Regional Director of Medicare STARs will be responsible for supporting regional and market STARs improvement efforts across all measures to increase UHC's performance on the CMS Medicare STARs program. The role will partner directly with market, regional, and national leaders to plan and execute performance improvement strategies and lead market and regional implementation of programs and processes designed to improve clinical and operational measures for the more than 2 million Medicare Advantage members in the West. This role will work closely with UHC National, Regional, and Market leaders and Health Plan executives to build relationships and lead cross-functional teams to drive STAR Ratings improvement through innovation, strategy development, and operational excellence.

If you are located in Seattle, WA, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:
  • Actively coordinates with all Medicare & Retirement national, regional and local functions (National Programs, Optum Quality Field Organization, Member Experience, Local Market Leadership etc.) to ensure that M&R West Region has all the right tactics to maintain all of its Health Plans at a 4+ Star performance level on an annual basis. Includes leveraging local market knowledge and establishing and/or driving local tactical plans for improving CMS Star ratings in all markets
  • Lead market and regional development and execution of strategic performance improvement plans to improve health plan STARs results and achieve market and contract performance goals
  • Lead and support market and regional leadership (including executive and clinical leaders) in the development and execution of programs that support increased performance on HEDIS, Part D, and Operational STARs measures
  • Provide strategic and tactical direction to the market and field-based Stars resources; approve performance targets / metrics; ensure performance to targets. Includes positive physician HEDIS run-rate performance; development and use of appropriate supporting tools (National, CAHPS/HOS tools, documentation training)
  • Analyze and interpret data to identify trends, solve complex problems, and develop strategic plans to drive STARs improvement within the health plan
  • Act as a HEDIS and STARs subject matter expert and resource for market and regional leaders and teams
  • Utilizes, integrates, and interprets data from various sources to lead regional and market teams in improvement efforts, and promote distinguished operational and clinical performance
  • Identify, document, and disseminate best and worst practices for achieving high performance on HEDIS and Operational measures and provide input back to national, regional, and market leadership
  • Create, develop, and drive process improvement plans for markets and contracts that are performing below goal on STARs measures
  • Represent and advocate for the region when working with functional business leaders and teams (Network, Clinical, Marketing, Sales, Customer Service, etc.) to develop and deploy initiatives to improve HEDIS and Operational performance, as well as improve overall STARs performance
  • Predicts and understands industry regulations that impact the CMS STARs program and measures and incorporates them into short and long-term business planning and regional and market strategies
  • Develops and maintains strong collaborative relationships within UHC Government Programs, including executives, regional and national leaders
  • Lead special projects and/or activities as requested by national, regional, and market leadership
  • Direct and support long-term and day-to-day work of direct reports, along with supporting their ongoing professional and personal development goals

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
  • Bachelor's Degree in business administration, finance, or healthcare-related field
  • 5+ years of experience with CMS Star ratings and/or HEDIS measures and clinical quality
  • 5+ years of experience in a large, complex and successful health care / managed care organization with demonstrated track record of increasing responsibility and accountability
  • 5+ years of experience monitoring data (quantitative and qualitative) performance measurement and facilitate feedback to improve performance and/or processes
  • Proficiency in MS Office Suite experience, advanced user in Power Point, Excel
  • Solid facilitation and organizational development skills
  • Telecommuter based position with 25% travel

Preferred Qualifications:
  • Master's degree
  • In-depth knowledge of Star Measure Technical Specifications
  • In-depth knowledge of the engagement strategies to improve Star Measure performance
  • Solid written and verbal communication skills, including well-developed interpersonal skills used to influence the behavior of others across a highly-matrixed organization
  • Track record of meeting business goals via driving disciplined, fact-based decisions and executing with discipline and urgency
  • Demonstrated success building relationships with external executives and stakeholders
  • Demonstrated solid analytical skills
  • Ability to plan, organize and be flexible in response to shifting priorities and multiple clients

Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time 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: CMS Star, HEDIS, Healthcare Management, Data Monitoring, Medicare, Seattle, Washington, WA, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote