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Elevance Health
Elevance Health
H1B Visa SponsorB2BHealthcareHealthcare Insurance
Elevance Health is a healthcare and health insurance company building a broader, long-term approach to supporting people’s health. Its work combines health benefits, integrated whole-health services, and digital health capabilities designed to connect care and coverage more effectively. With a workforce of nearly 100,000 associates serving more than 118 million people, Elevance Health offers roles across a large, multidisciplinary organization focused on improving health outcomes, evolving the healthcare system, and supporting stronger communities.
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Medicare CAHPS and STAR Quality Clinical Program Manager

Lead Medicare Star Ratings, CAHPS, and patient-experience quality programs at Elevance Health. Develop compliant clinical tools, manage vendors, and measure program outcomes.

USUnited StatesFLFloridaMOMissouriNCNorth CarolinaOHOhioHybridFull-timeMiddleSeniorEnglish RequiredClinical Operations

Description

  • Manage clinical programs supporting population-based quality measures, including Medicare Star Ratings, across clinical areas and lines of business.
  • Provide strategic direction for Medicare clinical and quality initiatives, including Stars, CAHPS, and account management.
  • Guide Medicare quality and patient-experience programs from concept through implementation.
  • Manage vendor contracts, negotiations, service-level agreements, and ongoing performance monitoring.
  • Build workflows, set priorities, and coordinate multiple projects to meet deadlines.
  • Apply industry practices, medical research, and other resources to create clinical programs and tools that support quality and cost-effective care.
  • Create and execute annual plans covering program strategies, initiatives, and tools.
  • Direct clinical program development activities.
  • Coordinate presentations, communications, and implementation across each phase of clinical program and tool development.
  • Maintain compliance with regulatory requirements and applicable state and federal laws and policies.
  • Identify system capabilities needed to implement clinical programs.
  • Define system requirements and return on investment.
  • Monitor program performance and results, making changes when needed.
  • Lead and advise associates involved in program development and implementation.

Requirements

  • Bachelor’s degree in business, public health, nursing, epidemiology, biostatistics, or a related discipline.
  • At least five years of experience analyzing healthcare data and developing clinical programs, or an equivalent combination of education and experience.
  • Ability to design AI prompts for healthcare solutions.
  • Proven ability to improve the healthcare member experience.
  • Experience conceiving, developing, and implementing Medicare Star, provider, or CAHPS quality programs.
  • Demonstrated experience improving programs.
  • Vendor management experience is preferred.
  • Medicare Part D experience is preferred.
  • Experience successfully managing member populations is preferred.
  • Comprehensive knowledge of CMS regulations governing Star Ratings.
  • Strong analytical capabilities.
  • Must live within reasonable commuting distance of a listed posting location unless an accommodation is approved.
  • New hires in certain patient- or member-facing roles must receive COVID-19 and influenza vaccinations unless an acceptable explanation is provided.

Benefits

  • Merit-based salary increases
  • Paid holidays
  • Paid time off
  • Incentive bonus programs
  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Short-term disability coverage
  • Long-term disability coverage
  • 401(k) plan with employer match
  • Employee stock purchase plan
  • Life insurance
  • Wellness programs
  • Financial education resources
  • Hybrid work flexibility
  • Accommodation support for qualified applicants

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