Medicare Stars Director

Job Description
Responsible for directing the overall development, management, and implementation of Aetna's Local Medicare Stars strategies for a region/market to ensure alignment around strategy, investment, activity, and innovation between Stars corporate and market partners.

Develops and executes on a local market CAHPS action plans through/by:

Proactive efforts to address impacts to Medicare stars through direct partnership with operations, Sales, and corporate stakeholders leveraging existing key tools and process.

Monitor trends and escalate key areas of concerns using available member experience data (CTMs, Grievances, CAHPS, Call Drivers, etc) and partner with appropriate corporate function to remediate.

Support corporate efforts to Improve clinical Measures: HEDIS, Medication Adherence, HOS etc.

Partner with the Clinical Strategist and Engagement Manager to accelerate clinical improvement at the provider level through improved data collection and action planning.

Identify local initiatives through collaboration with Stars Strategy Director to supplement corporate strategy and fit market dynamics.

Drive Non-VBC provider engagement and performance.

Work in a highly matrixed organization and collaborates closely with Regional Stars Strategy Director to execute corporate Stars strategy with consideration for local market factors, nuances, and relationships.

Accountable for leading and mentoring staff and transferring knowledge, best practices (external and internal), methodology and tools training within the market as needed.

Drive alignment between market bid development and Stars priorities to support product stability and access to care.

Responsible for providing oversight and supervision to external vendors, external consultants, team members and/or matrixed staff as required in support of local initiatives.

Leverages Stars dashboards and tools to conduct data analysis for to identify areas of opportunity and determine analytic priorities specific to Stars performance for the local market.

Required Qualifications
Success in leading cross-functional initiatives in a managed care setting.

Experience establishing and implementing new strategies to promote results.

Demonstrated ability to utilize data to identify issues and drive performance.

Experience in a managed care service operations role.

Excellent presentation and communication skills; prior training-related experience ideal.

Develop and foster strong internal and external relationships with senior level executives and junior level employees.

Desire and capability to both create strategy and execute tactically.

Ability to advocate effectively for internal support and change.

5+ years' experience in Medicare.

3+ years' experience in Medicare Stars.

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.
  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications
Master's degree

Experience in management consulting, project consulting, business process consulting, financial strategic analysis, and/or risk management consulting.

Bachelor's degree from an accredited college or equivalent work experience is required.

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.