Medicare CAHPS & STAR Quality Clinical Program Manager
About The Position
The Medicare CAHPS & STAR Quality Clinical Program Manager manages development of clinical programs for population-based quality measures, including Medicare Star, within a clinical area and across lines of business. The role provides strategic leadership for Medicare clinical and quality programs, overseeing account management, Stars, and CAHPS, and leads programs from ideation through implementation. The position evaluates industry best practices, medical research, and other resources to develop clinical programs and tools that support quality, cost-effective care. It develops an annual implementation plan, coordinates program presentations and communications, ensures regulatory compliance, identifies system needs and requirements, tracks results, and adjusts programs as needed. It also oversees vendor contracts and performance and provides guidance to associates involved in program development and implementation. The role is based in Mason, Ohio, with a hybrid schedule requiring on-site work one to two days per week. Alternate locations may be considered for candidates within commuting distance of an office.
Requirements
- Bachelor’s degree in business, public health, nursing, epidemiology, biostatistics, or a related field, and at least 5 years of experience involving healthcare data analysis and clinical program development; or an equivalent combination of education and experience.
- Excellent analytical skills.
Nice To Haves
- Skill in designing AI prompts for healthcare solutions.
- Demonstrated ability to improve member experience in healthcare.
- Experience developing and implementing Medicare Star, provider, and/or CAHPS quality programs.
- Demonstrated experience in program improvement.
- Vendor management experience.
- Medicare Part D experience.
- Experience managing member populations successfully.
- Thorough knowledge of CMS regulations related to CMS Star Ratings.
Responsibilities
- Provide strategic leadership for Medicare clinical and quality programs, overseeing account management, Stars, and CAHPS.
- Lead the ideation, development, and implementation of clinical Medicare quality and patient-experience programs.
- Oversee vendor contracts, negotiations, service-level agreements, and ongoing vendor performance.
- Create workflows, prioritize work, and manage multiple projects to meet deadlines.
- Evaluate industry best practices, medical research, and other resources to develop clinical programs and tools that support quality, cost-effective care.
- Develop an annual plan detailing strategies, programs, and tools to be implemented.
- Lead program development activities.
- Develop and coordinate presentations, communications, and implementation across all phases of clinical program and tool development.
- Ensure programs and tools comply with regulatory directives and state and federal laws and policies.
- Identify system needs for implementing clinical programs and develop system requirements and ROI.
- Track program performance and results, modifying programs as needed.
- Provide leadership and guidance to associates involved in program development and implementation.
Benefits
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs (unless covered by a collective bargaining agreement)
- Medical benefits
- Dental benefits
- Vision benefits
- Short- and long-term disability benefits
- 401(k) with 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
