Medicare Quality & Patient Experience Clinical Program Manager

About this role

Anticipated End Date: 2026-09-04 Position Title: Medicare Quality & Patient Experience Clinical Program Manager Job Description: Title : Medicare Quality & Patient Experience Clinical Program 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.

  Build the Possibilities. Make an Extraordinary Impact. 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 Medicare Quality & Patient Experience 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

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.

Who We Are Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal E

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