Medicare CAHPS & STAR Quality Clinical Program Manager

Elevance Health•Durham, NC

5d•Hybrid

About The Position

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. This role provides strategic leadership for Medicare clinical and quality programs, overseeing account management, Stars and CAHPS. It is responsible for the ideation through implementation of clinical part Medicare quality and patient experience programs. The role oversees vendor contracts, negotiations and service-level agreements and continuously monitors vendor performance. The ability to create workflows, prioritize work and manage multiple projects while meeting deadlines is essential. The role evaluates industry best practices, medical research and other resources to develop clinical programs and tools which facilitate and support quality, cost-effective care. It develops and implements an annual plan detailing the strategies, programs and tools to be implemented, and leads program development activities. The role develops and coordinates presentations, communications and implementation for all phases of the clinical programs/tools development and implementation. It ensures all programs and tools are compliant with regulatory directives and state/federal laws and policies, identifies system needs to implement clinical programs, and develops system requirements and ROI. The role tracks program performance and results and modifies as needed, and provides leadership and guidance to associates involved in program development and implementation activities.

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.

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

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.