Senior Manager, Stars and Clinical Initiatives

Job Summary

Established in 1997, L.A. Care Health Plan is an independent public agency providing health coverage to low-income Los Angeles County residents. The Senior Manager, Stars and Clinical Initiatives is responsible for developing and managing improvement programs for Dual Eligible Special Needs Plan (D-SNP) and Covered California lines of business to elevate Stars performance. The focus is on achieving higher Star ratings by driving sustained improvement in clinical quality, member experience, pharmacy performance, and operations.

Duties

• Lead the development, implementation, and continuous improvement of clinical and quality improvement programs that support D-SNP and Covered California Star performance.
• Collaborate closely and build cross-functional alignment with internal teams to develop and implement evidence-based best practices.
• Serve as Medicare and Covered California Stars subject matter expert and strategic thinker while also being a hands-on, operational and execution-focused leader.
• Analyze data, distill actionable insights, and incorporate into program evaluations and data-driven continuous improvement strategies.
• Deliver reports to required committees and workgroups.
• Stay updated on industry trends and best practices including around the application of Artificial Intelligence (AI) tools to improve quality of care, member experience, and member outcomes.
• Support the adoption of new technology and innovation to elevate Stars performance and member outcomes.
• Engage with external stakeholders including vendors, community organizations, and other solution providers to build new partnerships that elevate Stars performance and services for members.
• Identify and manage Centers for Medicare and Medicaid Services (CMS) and state regulatory updates and risks to ensure compliance with standards.
• Execute risk mitigation activities.
• Manage staff and day-to-day activities in the department.
• Participate in the department budgeting process.
• Support Medi-Cal and Personal Assistance Services Council-Service Employees International Union (PASC-SEIU) improvement initiatives as needed.

Qualifications

• At least 7 years of Medicare Stars experience including experience driving measurable improvement in quality metrics and Star ratings within a health plan.
• At least 5 years of leadership experience with proven ability to motivate and develop team members.
• At least 5 years of leading staff, supervisor/management experience.
• Experience leading and supporting initiatives aimed at transforming care delivery and improving health outcomes for vulnerable populations through a service-oriented, mission-driven approach.
• Experience leading teams, projects, or cross-functional groups.