What are the responsibilities and job description for the STARS Quality Specialist position at Mass General Brigham Health Plan?
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
oTrack performance on CMS Star Ratings measures across HEDIS, CAHPS,
HOS, pharmacy, and operational metrics.
oPrepare routine and ad hoc reports for leadership, quality teams, and
operational partners.
oIdentify performance gaps using data analysis and recommend targeted
interventions.
oMaintain dashboards, scorecards, and measure level documentation.
oA subject matter expert for the STARS analytics tool
Quality Improvement Support
oAssist in developing and executing quality improvement initiatives to raise
Star Ratings.
oSupport provider and member outreach campaigns aimed at closing care
gaps.
oCoordinate with clinical teams to ensure timely completion of preventive
screenings, chronic condition management, and medication adherence
activities.
oMonitor progress of interventions and escalate issues when performance
lags.
Cross-Functional Collaboration
oWork closely with departments such as Quality, Clinical Operations,
Member Experience, Provider Relations, Pharmacy, and IT.
oSupport provider engagement efforts, including distributing measure
education, performance summaries, and best practices.
oParticipate in internal workgroups focused on improving specific STARS
measures.
Regulatory & Compliance Support
oStay current on CMS Star Ratings methodology, technical specifications,
and regulatory updates.
oEnsure internal processes align with CMS requirements and audit
expectations.
oAssist with documentation for audits, mock audits, and compliance
reviews.
Program Coordination & Administration
oManage timelines, deliverables, and project tracking for STARS initiatives.
oSupport vendor coordination, including data exchange, reporting, and
performance monitoring.
oMaintain organized records of program activities, interventions, and
outcomes.
oAssist with annual planning for STARS strategy and operational execution.
oHelp design and execute outreach campaigns to improve member
experience and close gaps in care.
oSupport provider education on measure requirements, coding accuracy, and documentation standards.
oCoordinate distribution of materials, toolkits, and communications.
Process Improvement
oIdentify workflow inefficiencies and recommend enhancements to improve
measure performance.
oSupport implementation of new tools, processes, or technologies that
streamline STARS operations.
oDocument standard operating procedures (SOPs) and maintain process
guides.
oBreaks complex topics into meaningful chunks of information.
oSeeks out multiple sources to gather information.
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.
Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.
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.
Working Conditions
- This is a remote role that can be done from most US states
Mass General Brigham Health Plan Holding Company, Inc. is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. 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.
Our promise as a people-first organization starts with our employees. AllWays Health Partners is committed to diversity, equity, and inclusion in our workforce, internal culture, and investments. As an equal opportunity employer, AllWays Health Partners recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives, and backgrounds.