Manager, Quality and Stars, Health Plan
Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Work Shift: Day (United States of America) Scheduled Weekly Hours: 40 Compensation: Union Position: No Department Details
Summary
The Manager, Quality & Stars is responsible for identification, development and implementation of strategic programs with significant focus on Health Plan ratings and performance monitoring for governmental agencies, including CMS Star Ratings and BadgerCare HMO Pay-for-Performance. This position works collaboratively with internal teams, provider partners and vendors to develop implement and monitor continuous improvement plans that includes programs, services and tactics to allow the Health Plan to lead the industry in quality programs designed to improve member experience and clinical outcomes.
Job Description
This strategic leadership role oversees the organization's value-based performance, with a primary focus on the CMS Medicare Star Ratings program, BadgerCare Pay-for-Performance, and NCQA technical specifications. The individual is responsible for the end-to-end management of the Stars Program, from analyzing regulatory guidance and identifying performance risks to implementing tactical work plans and dashboards that track intervention success. By collaborating across departments and with data analytics partners, they drive improvements in clinical care, provider engagement, and member communication to maximize quality scores and ensure compliance with evolving federal requirements. In addition to technical and analytical oversight, the position serves as a central subject matter expert and people leader. The individual is responsible for educating the organization on the financial and operational impacts of improved ratings, managing external vendor relationships, and presenting performance strategies to senior leadership. As a manager, they are tasked with coaching, mentoring, and developing their team, ensuring staff are well-equipped to navigate complex quality rating systems like the Marketplace QRS. Additional duties as assigned.
Qualifications
Bachelor’s degree in business administration, healthcare administration, or related field required. Masters degree preferred. Five years of experience in managing quality or performance in the payor or provider space, required. Demonstrated outcomes and knowledge of reporting and analysis of healthcare related data. Experience in project management in healthcare industry and/or experience in health plan quality performance and ratings, preferred. Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to [email protected].