Clinical Program Development Manager

Clinical Program Development Manager

Location:
Mason, OH

Hybrid: 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 Clinical Program Development 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.

Primary duties may include, but are not limited to:

• 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.

• 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.

• 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.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

Applicants who require accommodation to participate in the job application process may contact elevancehealthj for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.