Clinical Program Development Manager

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.

CarelonRx is a proud member of the Elevance Health family of companies. CarelonRx pairs a strong, clinical-first lens with deep pharmacy expertise to create solutions that improve outcomes, control costs, and enhance each member's health.

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.

- 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.

- 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.

- 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.

- Demonstrated ability in improving member experience in healthcare

- Experience in ideation, development and implementation of Quality Medicare Star, Provider and/or CAHPS programs

- Experience with successfully managing member populations preferred

- Thorough knowledge of CMS regulations related to CMS Star Ratings