Stars Quality Specialist - Pennsylvania

JOB SUMMARY

At ConcertoCare, we are redefining care and aging for millions of US seniors and other adults with complex care needs by delivering human-first, tech-enabled care in the home. Our care teams leverage our value-based, interdisciplinary care model to address unmet health and social needs and to improve quality of life for our patients. We take a holistic, equitable, and compassionate approach to health and wellness in partnership with our patients and their families, caregivers, and communities. In short, we strive to offer the kind of healthcare that we would want our own loved ones to experience.

The values we aspire to in delivering on our patient-centered mission every day include:

• Deliver exceptional care
• Honor our patients
• Be a partner of choice
• Cultivate a world-class workplace
• Embrace change
• Do the right thing

The ConcertCare Stars Quality Specialist has direct impact to the overall quality performance by assisting the care team with medication and HEDIS related functions, reporting and improvement work efforts. The primary goal of the Stars Quality Specialist team is to work a variety of quality measures, including pharmacy and clinical measures, on behalf of our clients to continually improve and maximize Star ratings.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Direct impact on variety of Stars measures and activities, including Medication Adherence, portable device monitoring, market quality dashboard reviews, individual measure improvement plans, and Q4 pushes to maximize Star ratings.
• Detail oriented tasks including reviewing and auditing charts to ensure accurate documentation is occurring across the care team and looking for opportunities to improve Stars performance.
• Use data and reporting to drive decision making, prioritize work efforts, maximize performance, and close quality gaps.
• Telephonic outreach efforts include interacting with members, providers, pharmacies, ConcertoCare team members, and other key stakeholders.
• Strong communication skills and ability to interact with a variety of team members.
• Responsible for interacting with other departments to assist with member problems or questions, and act as facilitator to resolve them.
• Document completed work efforts in approved format and following outlined processes.
• Assist in day-to-day quality tasks as needed, including tracking and monitoring Stars related activities.
• Attend scheduled team meetings and provide relevant feedback regarding workflow issues.
• Organizational skills, including ability to prioritize tasks and ability to succeed in a fast-paced environment.
• Know and continually review medication brand and generic names, medical terminology, and pharmaceutical calculations.

QUALIFICATIONS

• Understanding of Medicare Star ratings program and how to influence Star ratings
• Healthcare industry and/or health insurance work experience
• Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint
• Experience and/or ability to work with electronic health record system
• Bachelor’s degree preferred
• Completion of an accredited Pharmacy Technician Program preferred

Compensation for the role is commensurate with the candidate’s qualifications, skills, competencies, and experience and may fall outside of the range shown. ConcertoCare offers a competitive total rewards package, which includes full healthcare coverage, a 401K with match, and a broad range of other health, wellness, and financial benefits.

We are an Equal Opportunity Employer. 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. 

ConcertoCare is an Alcohol/Drug/Smoke-Free Workplace.