STARS Quality Specialist

Site: Mass General Brigham Health Plan Holding Company, Inc. 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.