Quality Performance & Provider Engagement Manager

Ultimate Health Plans, Inc. (“UHP”) is a fast growing Medicare Advantage health plan with its headquarters located in Spring Hill, Florida. UHP plans provide all the benefits of Original Medicare Parts A and B, plus additional benefits not available with Original Medicare.

The Quality Performance & Provider Engagement Manager is responsible for the day-to-day management and execution of Medicare Advantage Quality and Star Ratings operations, with a strong focus on provider engagement, HEDIS performance, quality improvement, performance monitoring, and operational execution. This role serves as a key operational partner to the Director of HEDIS and Stars Operations and as a primary Quality liaison to PCPs, specialists, IPAs, and other provider organizations.

The Manager will oversee provider performance activities from identification of opportunities through outreach, meetings, action planning, follow-up, and measurement of results.The position will also coordinate the operational activities necessary to support the health plan's Quality and Stars strategy, including performance tracking, workplan management, provider meetings, internal cross-functional meetings, reporting, HEDIS gap-closure initiatives, and follow-up on improvement activities.The ideal candidate is highly organized, data-driven, comfortable working directly with provider leadership, and able to independently manage multiple Quality and Stars initiatives from performance identification through execution and follow-through.

Provider Engagement & Performance Management

• PCP and IPA relationships
• Provider performance meetings
• Scorecards and action plans
• Provider education
• Performance interventions
• Follow-up and accountability

HEDIS & Star Ratings Management

• Measure performance monitoring
• HEDIS gap closure
• Stars improvement initiatives
• Part C and Part D performance
• CAHPS and patient experience
• Performance risks and opportunities

Quality Operations & Program Management

• Day-to-day Quality operations
• Quality improvement initiatives
• Workplans, deadlines, and deliverables
• Cross-functional coordination
• Vendor initiatives
• Operational issue resolution

Meeting Management & Follow-Through

• Provider and IPA performance meetings
• Internal Quality/Stars meetings
• Agendas and presentations
• Meeting preparation
• Action-item tracking
• Follow-through to completion

Performance Reporting & Leadership Support

• Quality dashboards and reporting
• Performance trends
• Executive presentations
• Stars forecasting
• Strategic planning
• Direct support to the Director

Experience:

• Managed Care: 1 year (Required)
• Utilization review: 1 year (Required)

Work Location: In person

CSTS is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All employment decisions are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion, sex (including pregnancy and gender identity), sexual orientation, national origin, age, disability, genetic information, or veteran status.

Job Type: Full-time

Pay: From $70,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Salary : $70,000