Prime Therapeutics Sr Dir Star Rating & Quality COE – Remote in Helena, Montana

March 30, 2024

Job Description


Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Sr Dir Star Rating & Quality COE – Remote

Job Description

Responsibilities:

  • Formulate strategic and tactical plans, processes, and tools relative to the highest standards of quality; establish and maintain quality procedures and processes that drive Star ratings and measurable results.

  • Develop a comprehensive Medicare Star Ratings and CAHPS strategy that meets the needs of clients to attract and retain members and achieve quality bonus payments.

  • Lead cross-functional Star / Quality COE workgroup and steering committee with key internal partners such as clinical programs, member experience, and data/analytic to drive synergies related to quality improvement and new product / program development for Prime’s Government Programs book of business. Provide strategic consultation and solutions to our clients that delivers on client’s strategic objectives.

  • Lead team of quality managers and data analysts, to provide work direction, budget, performance and development, resource planning, and consistently demonstrate Prime’s leadership expectations during interactions with direct reports, cross-functional and external stakeholders.

  • In partnership with Compliance and Government Affairs, ensure proactive monitoring/tracking, review, and response to proposed regulatory policy and contract obligations as applicable to Medicare Star Ratings and other quality program changes. Interact with key industry quality leaders and position Prime as a leader in this space through measurable and sustained year over year results / improvement.

  • Develop, implement, manage, and maintain tools, technology, and processes to support Star rating and quality performance.

  • Lead competitive market analysis and identify new trends and opportunities to inform Star rating and quality strategy and position Prime for growth.

  • Participate in GP Strategy and other workgroups to integrate quality / Medicare Star Ratings lens into our daily work looking for ways to drive efficiency, improve processes, and enhance member experience in alignment with the Centers for Medicare & Medicaid Services (CMS) program requirements.

  • Develop quality specific data needs / solutions for Star Rating performance management and insights development. Partner with enterprise data and analytics team to enhance tools and capabilities to drive efficiencies and flexibility for client specific needs. Represent Prime Quality Programs in RFP responses, at industry conferences, and at current and prospective client / finalist meetings.

  • Other duties as assigned

Minimum Qualifications:

  • Bachelor’s degree in business, health services or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required

  • 10 years of work experience in Medicare Star Rating quality programs, analytics, audit, compliance, operational compliance, or related field

  • 7 years of leadership/people management experience

  • Must be eligible to work in the United States without need for work visa or residency sponsorship

Additional Qualifications:

  • Strategic planning and execution

  • Excellent written and verbal communication skills with the demonstrated ability of presenting program and project updates to senior executives

  • Strong organizational, analytical, interpretative, and time management skills

  • Strong interpersonal skills including team leadership and collaboration

  • Understanding of CMS Star Rating regulatory requirements / technical specifications

  • Strong commitment and proven track record of continuous quality improvement

  • Demonstrated ability to identify and develop quality programs and process improvements

Preferred Qualifications:

  • Experience working with cross-functional partners both internally and externally

  • Experience with analytical tools such as Excel, Access data bases, SaaS

  • Strong client consulting presence: ability to distill complex material into easy to understand presentations, effectively respond to questions and engage a variety of audiences

  • Ability to communicate effectively with senior leaders across the organization

Minimum Physical Qualifications:

  • Travel required up to 25% of time

  • Constantly required to sit, use hands to handle or feel, talk and hear

  • Frequently required to reach with hands and arms

  • Occasionally required to stand, walk and stoop, kneel, and crouch

  • Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds

  • Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus

Reporting Structure:

  • Reports to VP Client Strategy Government Programs

Potential pay for this position ranges from $144,000.00 – $230,200.00 based on experience and skills. Pay range may vary by 8% depending on applicant location.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page (https://www.primetherapeutics.com/careers/benefits/) and click on the “Benefits at a glance” button for more detail.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.

Positions will be posted for a minimum of five consecutive workdays.

Prime Therapeutics’ fast-paced and dynamic work environment is ideal for proactively addressing the constant changes in today’s health care industry. Our employees are involved, empowered, and rewarded for their achievements. We value new ideas and work collaboratively to provide the highest quality of care and service to our members.

If you are looking to advance your career within a growing, team-oriented, award-winning company, apply to Prime Therapeutics today and start making a difference in people’s lives.

Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status. If you are an applicant with a disability and need a reasonable accommodation for any part of the employment process, please contact Human Resources at 1.866.469.1257 or email [email protected].









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