Clinical Program Development Manager
About The Position
The Clinical Program Development Manager is responsible for managing clinical program development for population-based clinical quality measures, including HEDIS within a clinical area and across all lines of business. 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. 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.
Requirements
- 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.
Nice To Haves
- 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
Responsibilities
- 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.
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical
- dental
- vision
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
