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Medicare CAHPS & STAR Quality Clinical Program ManagerElevance Health • Durham, NC, United States
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Medicare CAHPS & STAR Quality Clinical Program Manager

Medicare CAHPS & STAR Quality Clinical Program Manager

Elevance Health • Durham, NC, United States
13 days ago
Job type
  • Full-time
Job description

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

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Medicare CAHPS & STAR Quality Clinical Program Manager • Durham, NC, United States

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