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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

About the role

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.

Responsibilities

• Oversees vendor contracts, negotiations and service-level agreements and continuously monitors vendor performance.
• Creates workflows, prioritizes work and manages 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.

Requirements

• 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.

Skills

• 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

Benefits

• 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

Schedule

Hybrid Workforce Strategy: 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.