Medicare CAHPS & STAR Quality Clinical Program Manager

Job Description

Job Description

Title : Medicare CAHPS & STAR Quality Clinical Program Manager

Location: Mason, OH

Hybrid: This role requires associates to be in-office 1 - 2  days 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.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

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

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