Medicare CAHPS & STAR Quality Clinical Program Manager
Location: Mason, OH
Hybrid: This role requires associates to be in-office 1 - 2days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.
Build the Possibilities. Make an Extraordinary Impact.
CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member's health.
The Medicare CAHPS & STAR Quality Clinical Program Manager is responsible for managing clinical program development for population-based clinical quality measures, including Medicare Star within a clinical area and across all lines of business.
How you will make an impact:
- Provides strategic leadership for Medicare clinical and quality programs, overseeing account management, Stars and CAHPS.
- Responsible for ideation through implementation of clinical part Medicare quality and patient experience programs.
- Oversees vendor contracts, negotiations and service-level agreements and continuously monitors vendor performance.
- Ability to create workflows, prioritize work and manage multiple projects while meeting deadlines
- Evaluates industry best practices, medical research and other resources to develop clinical programs and tools which facilitate and support quality, cost-effective care.
- Develops and implements an annual plan detailing the strategies, programs and tools to be implemented.
- Leads program development activities.
- Develops and coordinates presentations, communications and implementation for all phases of the clinical programs/tools development and implementation.
- Ensures all programs and tools are compliant with regulatory directives and state/federal laws and policies.
- Identifies system needs to implement clinical programs.
- Develops system requirements and ROI.
- Tracks program performance and results and modifies as needed.
- Provides leadership and guidance to associates involved in program development and implementation activities.
Minimum Requirements:
- Requires a BA/BS in business, public health, nursing, epidemiology biostatistics, or related field and minimum of 5 years experience involving analyses of health care data and clinical program development; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
- Skilled in designing AI prompts for healthcare solutions
- Demonstrated ability in improving member experience in healthcare
- Experience in ideation, development and implementation of Quality Medicare Star, Provider and/or CAHPS programs
- Demonstrated experience in program improvement
- Experience with vendor management preferred
- Medicare Part D experience preferred
- Experience with successfully managing member populations preferred
- Thorough knowledge of CMS regulations related to CMS Star Ratings
- Excellent analytical skills
Job Level: Non-Management Exempt
Workshift: 1st Shift (United States of America)
Job Family: BSP > Program/Project