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Medicare CAHPS & STAR Quality Clinical Program Manager
Elevance Health. Manage clinical program development for population-based clinical quality measures, including Medicare Star, within a clinical area and across all lines of business .
About the role
Key responsibilities & impact- Manage clinical program development for population-based clinical quality measures, including Medicare Star, within a clinical area and across all lines of business
- Provide strategic leadership for Medicare clinical and quality programs, overseeing account management, Stars and CAHPS
- Lead ideation through implementation of clinical Medicare quality and patient experience programs
- Oversee vendor contracts, negotiations and service-level agreements; continuously monitor vendor performance
- Create workflows, prioritize work and manage multiple projects while meeting deadlines
- Evaluate industry best practices, medical research and other resources to develop clinical programs and tools supporting quality, cost-effective care
- Develop and implement an annual plan detailing strategies, programs and tools
- Lead program development activities
- Develop and coordinate presentations, communications and implementation for all phases of clinical program/tool development and implementation
- Ensure programs and tools comply with regulatory directives and state/federal laws and policies
- Identify system needs to implement clinical programs
- Develop system requirements and ROI
- Track program performance and results and modify programs as needed
- Provide leadership and guidance to associates involved in program development and implementation
Requirements
What you’ll need- Requires a BA/BS in business, public health, nursing, epidemiology biostatistics, or related field
- Minimum of 5 years experience involving analyses of health care data and clinical program development; or any combination of education and experience providing an equivalent background
- 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
- Candidates must reside within a reasonable commuting distance from a posting location unless an accommodation is granted
- New candidates in certain patient/member-facing roles must become vaccinated against COVID-19 and Influenza, unless an acceptable explanation is provided
Benefits
Comp & perks- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) with match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Hybrid work flexibility
- Accommodation support for qualified applicants