Anticipated End Date:2026-10-30
Position Title:Medicare CAHPS & STAR Quality Clinical Program Manager
Job Description:Title:
Medicare CAHPS & STAR Quality Clinical Program ManagerLocation: Mason, OHHybrid: 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.
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
- 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
#EHS #LI
Job Level:Non-Management Exempt
Workshift:1st Shift (United States of America)
Job Family:BSP > Program/Project
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.
NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words - the job is posted until 3/13, not through 3/13.
