Medicare Quality Administrator

McLaren Health Plan (MHP) is a company with a culture of high performance and a mission to help people live healthier and more satisfying lives. We are looking for a Medicare Quality Administrator to join us in leading the organization forward. 

 MHP is a Managed Care Organization dedicated to meeting the health care needs of each member. MHP offers multiple product lines, including individual and family plans, and Medicaid and Medicare plans to Michigan residents for every stage of life. MHP is accredited by the National Committee for Quality Assurance (NCQA).

 MHP values the talents and abilities of all our employees and seeks to foster an open, cooperative and dynamic environment in which employees and the health plan can thrive. As an employee of MHP, you will be a part of an organization that considers all our employees as leaders in driving the organization forward and delivering quality service to all our members.

 Learn more about McLaren Health Plan at https://www.mclarenhealthplan.org 

Position Summary:

Responsible for delivering, strategizing, and improving quality performance with a focus on Medicare Star ratings. This position supports the design, development, implementation, and evaluation of quality programs focused on improving the plan’s Medicare Star ratings. This individual will collaborate with leadership and cross-functional teams to support the design and execution of quality-related projects and programs to advance organizational priorities related to quality performance. Responsible for proposing targeted actions, aiding in the development of the interventions and coordinating the implementation of all quality operations. Coordinates specific regulatory and contractual responsibilities including, but not limited to, HEDIS, CAHPS, HOS, and NCQA Standard compliance, performance projects, site audits, and any other regulatory requirements.

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Qualifications:

Required:
•    Bachelor’s degree in health care, business or a related field, or Associate’s degree and two (2) years’ related experience.
•    Two (2) years’ experience performing quality management activities in a Medicare managed care organization, including HEDIS, HOS, and CAHPS.
 

Preferred:
•    Master’s degree in health care related field.
•    Four (4) years’ experience with a government regulated health organization or a managed care setting with at least three (3) years’ experience performing complex quality management activities including HEDIS, NCQA etc.
•    In-depth understanding of claims administration as it pertains to provider payments, including CPT-4 codes, revenue codes, HCPCS codes, DRGs, etc.
•    Experience and knowledge of ICD-10, CPT I, CPT II, LOINC, SNOMED, HCPCS diagnosis.