Manages clinical program development for population-based clinical quality measures, including Medicare Star
Oversees vendor contracts, negotiations and service-level agreements
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 clinical programs/tools development and implementation
Ensures all programs and tools are compliant with regulatory directives and state/federal laws
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

Requires a BA/BS in business, public health, nursing, epidemiology biostatistics, or related field
Minimum of 5 years experience involving analyses of health care data and clinical program development
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

Clinical Program Development Manager

Key skills