Medicare CAHPS & STAR Quality Clinical Program Manager

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
• Experiencein 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

#EHS #LI

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.