Sr. Manager, STAR Quality Programs

SCAN Health Insurance•California, MO

4d•$125,400 - $181,419•Remote

About The Position

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve. This role is responsible for managing, developing, and overseeing quality and clinical programs associated with organizational and department STAR initiatives. This role involves identifying quality program risks and developing a risk mitigation strategy, collaborating with various internal departments to implement best practices, and monitoring and reporting on program performance to ensure continuous improvement of STAR ratings and member outcomes. As a key business leader, you will be responsible for managing, developing, and overseeing quality and clinical programs associated with organizational and department STAR initiatives. This role ensures the identification and management of quality program risks, the implementation of mitigation strategies, and the collaboration with various internal departments to develop and implement best practices that result in improved ratings and enhanced patient outcomes. The Manager will also monitor and report on program outcomes performance, KPI, delivering actionable insights, interventions, and impact to workgroups and committees. You Will Manage, Develop, and Oversee Quality and Clinical Programs: Lead the planning, implementation, and continuous improvement of quality and clinical programs aligned with organizational and department STAR initiatives. Ensure that all programs meet regulatory and accreditation standards, and are designed to enhance patient care and satisfaction. Identify and Manage Quality Program Risks: Conduct regular risk assessments to identify potential issues and vulnerabilities in quality programs. Develop and implement risk mitigation strategies to address identified risks and ensure program integrity and effectiveness. Collaborate with Internal Departments: Work closely with care management, customer service, outreach, product, sales, marketing, and other relevant departments to develop and implement best practice STAR initiatives. Facilitate cross-departmental communication and collaboration to ensure alignment and synergy in achieving quality and clinical goals. Monitor and Report on Program Performance: Regularly monitor and analyze program performance metrics to assess the effectiveness of quality and clinical initiatives. Prepare and present detailed reports to workgroups and committees, providing insights, interventions, and the impact of quality programs. Use data-driven insights to inform continuous improvement efforts and drive performance enhancements. Compliance and Regulatory Adherence: Ensure all quality and clinical programs comply with federal, state, and local regulations and accreditation standards. Stay informed about industry trends and best practices in quality and clinical management. Continuous Improvement: Foster a culture of continuous improvement within the quality and clinical teams. Encourage and support the adoption of innovative practices and technologies to enhance program effectiveness. Stakeholder Engagement: Engage with external stakeholders, such as regulatory bodies, healthcare providers, and community organizations, to build partnerships and enhance program impact. Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.) We seek Rebels who are curious about AI and its power to transform how we operate and serve our members. Actively support the achievement of SCAN’s Vision and Goals. Other duties as assigned.

Requirements

Bachelor’s Degree required.
5 years of related experience.
3-4 years of leadership experience.
Leadership - Skilled to develops others
Problem Solving - Make critical decisions, often involving high-level risk assessment and the ability to adapt to changing circumstances
Strategic Mindset - Formulates strategy and maps steps to achieve strategic goals
Strong leadership and project management skills.
Excellent analytical and problem-solving abilities.
Effective communication and interpersonal skills.
Proficiency in data analysis and reporting tools.
Ability to collaborate and build relationships with diverse stakeholders.
Knowledge of healthcare regulations and accreditation standards.

Nice To Haves

Graduate or Advanced Degree or equivalent experience preferred.
MBA, RN or Pharm D. preferred
Experience in managing and improving quality metrics, particularly in the context of STAR ratings, is highly desirable.
We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.

Responsibilities

Manage, Develop, and Oversee Quality and Clinical Programs: Lead the planning, implementation, and continuous improvement of quality and clinical programs aligned with organizational and department STAR initiatives. Ensure that all programs meet regulatory and accreditation standards, and are designed to enhance patient care and satisfaction.
Identify and Manage Quality Program Risks: Conduct regular risk assessments to identify potential issues and vulnerabilities in quality programs. Develop and implement risk mitigation strategies to address identified risks and ensure program integrity and effectiveness.
Collaborate with Internal Departments: Work closely with care management, customer service, outreach, product, sales, marketing, and other relevant departments to develop and implement best practice STAR initiatives. Facilitate cross-departmental communication and collaboration to ensure alignment and synergy in achieving quality and clinical goals.
Monitor and Report on Program Performance: Regularly monitor and analyze program performance metrics to assess the effectiveness of quality and clinical initiatives. Prepare and present detailed reports to workgroups and committees, providing insights, interventions, and the impact of quality programs. Use data-driven insights to inform continuous improvement efforts and drive performance enhancements.
Compliance and Regulatory Adherence: Ensure all quality and clinical programs comply with federal, state, and local regulations and accreditation standards. Stay informed about industry trends and best practices in quality and clinical management.
Continuous Improvement: Foster a culture of continuous improvement within the quality and clinical teams. Encourage and support the adoption of innovative practices and technologies to enhance program effectiveness.
Stakeholder Engagement: Engage with external stakeholders, such as regulatory bodies, healthcare providers, and community organizations, to build partnerships and enhance program impact.
Supervises/Manages Others (i.e. hires, performance reviews, corrective action, etc.)
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.

Benefits

Base salary range: $125,400 to $181,419 per year
Internal title - Sr. Mgr Care Quality Ops
Work Mode - Mostly Remote
An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
Excellent 401(k) Retirement Saving Plan with employer match and contribution
Robust employee recognition program
Tuition reimbursement
An opportunity to become part of a team that makes a difference to our members and our community every day!