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Fallon Health CMS 5 Star Program Manager - Remote in Worcester, Massachusetts


About Fallon Health

Founded in 1977, Fallon Health is a leading health care services organization that supports the diverse and changing needs of those we serve. In addition to offering innovative health insurance solutions and a variety of Medicaid and Medicare products, we excel in creating unique health care programs and services that provide coordinated, integrated care for seniors and individuals with complex health needs. Fallon has consistently ranked among the nation’s top health plans, and is accredited by the National Committee for Quality Assurance for its HMO, Medicare Advantage and Medicaid products. For more information, visit fallonhealth.org.

Brief Summary of Purpose:

Principle responsibility of the Medicare 5 star Program Manager is to collaborate with Fallon Health’s 5 Star owner to produce dashboards, trend and surveillance reports for senior management and department leaders and teams, tracking individual metric measure and executed intervention performance. This includes, a thorough performance review of end-to-end process across all Stars measures, inclusive of KPI identification, accountability tracking and review as well as oversight of all LOB activities and plans. Additionally this role will work with businessareas to design, develop, modify and test reports to support business needs and transaction management in support of Fallon’s 5 star rating goals. This includes engaging leaders and business owners to help define, shape and drive Stars performance. The analyst will leverage their analytic skill set and experience with large health care data sets to identify and communicate trends as well as prioritize and recommend improvements through data-driven analysis. The Medicare 5 star Program Manager will also be responsible for investigating specific areas of concern with 5 star performance. The objective of the Medicare 5 star Program Manager activities is to qualify Fallon Health performance with real time date with the goal of creating actionable activities to improve performance. It is also expected that this role proactively identifies and addresses scalability and performance bottlenecks to support efficiencies. They are consultative to the business and accountable for the quality and effectiveness of the data in the subject area across all related systems (QNXT, data warehouse) and are expected to be subject matter experts for this data.


  • Produce dashboards, trend and surveillance reports for senior management and department leaders and teams, tracking individual measure and interventions performance. Dashboard reports are based on real time cross sectional segments.

  • Analyzes and supports data analytics to easily identify Medicare Star measures for cultural trends (demographics, disparities and social determinants), operational inefficiencies and

  • provider practice patterns

  • Reviews current reports and outputs for accuracy, efficiency and viability

  • Gathers business requirements; determines most effective and efficient reporting platform

  • Review logic, criteria and definitions to incorporate into data models to extract functional data sets for reporting

  • Work closely with resources to develop outputs based on gathered requirements

  • Develops alternative techniques for gathering a variety of data that is not available from established sources

  • Assist in the identification of trends that impacts 5 Star ratings

  • Leverages mathematical calculations to determine integrity of data samples

  • Evaluates risks; collects statistical information to determine whether business areas have negative impacts on their businesses, or at least improve their business practices,

  • Consultative to business owners to applying analytical findings to the business.

  • Actively participate analyst meetings

  • Identifies improvements regarding report efficiencies and platform effectiveness

  • Works with business owners to research root cause and communicate improvement recommendations

  • Participates in continuing education activities to improve upon skills

  • Support design and execution of analytical roadmap in collaboration with organizational 5 star owner and domain experts to drive delivery of analytical projects that support relevant, actionable business insights.

  • Work collaboratively with Director and business owners

  • Provides assistance on technical matters and act as a significant information resource

  • Participant in cross functional initiatives


Bachelor Degree at a minimum; Advanced education preferred in health-related related field such as healthcare management or healthcare informatics; PMP and/or Six sigma a plus

SSMS (SQL Server Management Studio), Crystal Reports (if applicable), Business Objects / Web Intelligence, MS Visio, MS Office, other applications (SAS To be evaluated) a plus.

Location US-MA-Worcester

Posted Date 1 month ago (3/21/2024 1:32 PM)

Job ID 7532

# Positions 1

Category Data Management/Reporting