STARS Quality Specialist
Mass General Brigham
1 day ago
Full-time
Remote
United States
$63,648 - $90,750 USD yearly
Quality Jobs
Site: Mass General Brigham Health Plan Holding Company, Inc.
Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise.
We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.
The Quality STARS Specialist supports a clinical health plan's CMS Star Ratings performance by monitoring quality measures and translating data into actionable insights that improve care delivery, member experience, and outcomes. Partners with clinical, quality, pharmacy, provider, and operational teams to identify performance gaps, support outreach and care gap closure initiatives, and track progress across HEDIS, CAHPS, HOS, and related measures. Serving as a subject matter expert in Star Ratings methodology and analytics, supports regulatory compliance, audit readiness, program coordination, and process improvement to strengthen quality performance and operational effectiveness.
Principal Duties and Responsibilities:
Data Monitoring and Reporting
o Track performance on CMS Star Ratings measures across HEDIS, CAHPS,
HOS, pharmacy, and operational metrics.
o Prepare routine and ad hoc reports for leadership, quality teams, and
operational partners.
o Identify performance gaps using data analysis and recommend targeted
interventions.
o Maintain dashboards, scorecards, and measure level documentation.
o A subject matter expert for the STARS analytics tool
Quality Improvement Support
o Assist in developing and executing quality improvement initiatives to raise
Star Ratings.
o Support provider and member outreach campaigns aimed at closing care
gaps.
o Coordinate with clinical teams to ensure timely completion of preventive
screenings, chronic condition management, and medication adherence
activities.
o Monitor progress of interventions and escalate issues when performance
lags.
Cross-Functional Collaboration
o Work closely with departments such as Quality, Clinical Operations,
Member Experience, Provider Relations, Pharmacy, and IT.
o Support provider engagement efforts, including distributing measure
education, performance summaries, and best practices.
o Participate in internal workgroups focused on improving specific STARS
measures.
Regulatory & Compliance Support
o Stay current on CMS Star Ratings methodology, technical specifications,
and regulatory updates.
o Ensure internal processes align with CMS requirements and audit
expectations.
o Assist with documentation for audits, mock audits, and compliance
reviews.
Program Coordination & Administration
o Manage timelines, deliverables, and project tracking for STARS initiatives.
o Support vendor coordination, including data exchange, reporting, and
performance monitoring.
o Maintain organized records of program activities, interventions, and
outcomes.
o Assist with annual planning for STARS strategy and operational execution.
o Help design and execute outreach campaigns to improve member
experience and close gaps in care.
o Support provider education on measure requirements, coding accuracy, and documentation standards.
o Coordinate distribution of materials, toolkits, and communications.
Process Improvement
o Identify workflow inefficiencies and recommend enhancements to improve
measure performance.
o Support implementation of new tools, processes, or technologies that
streamline STARS operations.
o Document standard operating procedures (SOPs) and maintain process
guides.
o Breaks complex topics into meaningful chunks of information.
o Seeks out multiple sources to gather information.
Remote399 Revolution Drive40RegularDay (United States of America)8925 Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.
Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.
Job Summary
Mass General Brigham Health Plan is an exciting place to be within the healthcare industry. As a member of Mass General Brigham, we are on the forefront of transformation with one of the world’s leading integrated healthcare systems. Together, we are providing our members with innovative solutions centered on their health needs to expand access to seamless and affordable care and coverage.Our work centers on creating an exceptional member experience – a commitment that starts with our employees. Working with some of the most accomplished professionals in healthcare today, our employees have opportunities to learn and contribute expertise.
We are pleased to offer competitive salaries, and a benefits package with flexible work options, career growth opportunities, and much more.
The Quality STARS Specialist supports a clinical health plan's CMS Star Ratings performance by monitoring quality measures and translating data into actionable insights that improve care delivery, member experience, and outcomes. Partners with clinical, quality, pharmacy, provider, and operational teams to identify performance gaps, support outreach and care gap closure initiatives, and track progress across HEDIS, CAHPS, HOS, and related measures. Serving as a subject matter expert in Star Ratings methodology and analytics, supports regulatory compliance, audit readiness, program coordination, and process improvement to strengthen quality performance and operational effectiveness.
Principal Duties and Responsibilities:
Data Monitoring and Reporting
o Track performance on CMS Star Ratings measures across HEDIS, CAHPS,
HOS, pharmacy, and operational metrics.
o Prepare routine and ad hoc reports for leadership, quality teams, and
operational partners.
o Identify performance gaps using data analysis and recommend targeted
interventions.
o Maintain dashboards, scorecards, and measure level documentation.
o A subject matter expert for the STARS analytics tool
Quality Improvement Support
o Assist in developing and executing quality improvement initiatives to raise
Star Ratings.
o Support provider and member outreach campaigns aimed at closing care
gaps.
o Coordinate with clinical teams to ensure timely completion of preventive
screenings, chronic condition management, and medication adherence
activities.
o Monitor progress of interventions and escalate issues when performance
lags.
Cross-Functional Collaboration
o Work closely with departments such as Quality, Clinical Operations,
Member Experience, Provider Relations, Pharmacy, and IT.
o Support provider engagement efforts, including distributing measure
education, performance summaries, and best practices.
o Participate in internal workgroups focused on improving specific STARS
measures.
Regulatory & Compliance Support
o Stay current on CMS Star Ratings methodology, technical specifications,
and regulatory updates.
o Ensure internal processes align with CMS requirements and audit
expectations.
o Assist with documentation for audits, mock audits, and compliance
reviews.
Program Coordination & Administration
o Manage timelines, deliverables, and project tracking for STARS initiatives.
o Support vendor coordination, including data exchange, reporting, and
performance monitoring.
o Maintain organized records of program activities, interventions, and
outcomes.
o Assist with annual planning for STARS strategy and operational execution.
o Help design and execute outreach campaigns to improve member
experience and close gaps in care.
o Support provider education on measure requirements, coding accuracy, and documentation standards.
o Coordinate distribution of materials, toolkits, and communications.
Process Improvement
o Identify workflow inefficiencies and recommend enhancements to improve
measure performance.
o Support implementation of new tools, processes, or technologies that
streamline STARS operations.
o Document standard operating procedures (SOPs) and maintain process
guides.
o Breaks complex topics into meaningful chunks of information.
o Seeks out multiple sources to gather information.
Qualifications
Education
- Bachelor's Degree required (experience can be substituted in lieu of degree); Master's Degree preferred
Experience
- At least 2-3 years of experience in a CMS STARs role, specializing in STARs program execution required
- At least 2-3 years experience managing STARs data, data validation, and outcomes required.
- At least 5-7 years in health plan quality in a managed care organization highly preferred
- Experience in healthcare quality, STARs initiatives, population health, or related program coordination highly preferred
- Familiarity with QI methodologies and regulatory standards highly preferred
- Experience working with diverse communities or in community health, managed care, or hospital quality departments preferred
- Experience with SDOH screening tools, community partnerships, or health literacy initiatives preferred
- Certification in healthcare quality or equity (e.g., CPHQ, CPHE, Lean Six Sigma) preferred
Knowledge, Skills, and Abilities
- In-depth knowledge of healthcare regulations, accreditation standards, STARs program and quality improvement methodologies.
- Strong understanding of document management systems (DMS), such as SharePoint, OpenText, or Documentum, to manage digital files, track revisions, and maintain version control.
- Familiarity with cloud storage systems and collaboration tools like Google Drive, Dropbox, and Microsoft OneDrive.
- Experience with electronic records management (ERM) and data retention policies.
- Demonstrates awareness of importance of security, scalability, reliability and feasibility in solutions
- Seeks out information to better understand impacts of design and implementation of systems
- Evaluates service areas to identify opportunities for automation
- Ability to draft, revise, and implement company policies and standard operating procedures.
- Knowledge of compliance standards, including industry-specific regulations (e.g., healthcare HIPAA regulations, financial regulations, state and federal rules).
- Strong organizational skills to ensure policies and documents are properly filed, categorized, and easy to access.
- Ability to spot discrepancies or issues in documents and ensure compliance with required guidelines.
- Understanding of legal and regulatory requirements for document retention and management, including data privacy and security laws.
- Knowledge of audit procedures and the ability to prepare documentation for audits.
- Excellent written and verbal communication skills for drafting policies and procedures, as well as providing guidance to employees about document handling and compliance.
- Ability to train staff on document management practices and policy changes.
- Experience using document management software and workflow tools to streamline document processes and improve efficiency.
- Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and other productivity tools is often required.
- Familiarity with document control software for versioning, workflow management, and access permissions.
- Ability to manage multiple tasks or projects simultaneously, adhering to deadlines and ensuring that policies and documents are up to date.
- Experience with project management software, such as Trello or Microsoft Project, is beneficial.
- Ability to identify issues with document flow, retention, or compliance and propose solutions to resolve them.
- Strong critical thinking skills for analyzing policies and procedures to ensure they align with organizational goals and legal requirements.
- Excellent interpersonal skills, including the ability to influence others at all levels of an organization.
Additional Job Details (if applicable)
Working Conditions
- This is a remote role that can be done from most US states
Remote Type
Work Location
Scheduled Weekly Hours
Employee Type
Work Shift
Pay Range
$63,648.00 - $90,750.40/Annual
Grade
6
EEO Statement:
Mass General Brigham Competency Framework
At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.