Client Quality Manager Stars and Quality

Prime Therapeutics; Minneapolis (MN); On-site; USD 81,000 - 138,000; Full time

Job summary

A leading healthcare company seeks a Client Quality Manager to oversee quality initiatives for clients. The role involves analyzing quality data, collaborating with stakeholders, and ensuring compliance with quality standards. Candidates should have a Bachelor's degree and relevant experience in managed care or Pharmacy Benefit Management.

Qualifications

• 5 years of work experience in managed care or Pharmacy Benefit Management.
• Ability to effectively distill complex information into clear presentations.

Responsibilities

• Analyze clients' quality data to recommend improvement strategies.
• Drive the client quality strategy for all lines of business.
• Collaborate with stakeholders to ensure needs are understood.

Skills

Interpersonal Skills

Organizational Skills

Attention to Detail

Action-oriented

Education

Bachelor's degree in business administration

HS diploma or GED

Job description

Client Quality Manager Stars and Quality

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Client Quality Manager Stars and Quality

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Our work matters. We help people get the medicine they need to feel better and live well. We do not lose sight of that. It fuels our passion and drives every decision we make.

Job Posting Title

Client Quality Manager Stars and Quality

Job Description

The Senior Client Quality Manager ensures the successful planning, implementation and execution of all quality initiatives for assigned clients on behalf of the quality management area. This position works with client stakeholders at all organizational levels to develop quality related goals and ensure understanding of capabilities, reporting and quality plan needs, and products and services available to augment the client quality strategy. This role provides leadership and subject matter expertise on Medicare Stars, Medicaid quality and the Commercial/Health Insurance Marketplace Quality Rating System (HIM QRS). This position is also responsible to be a subject matter expert (SME) in an assigned quality area of focus, collaborating cross-functionally to ensure quality department goals are met, and meeting with clients regularly, including health plan leadership, to ensure effective planning and execution of quality plans.

Responsibilities

• Analyze clients' quality data to develop and recommend strategies for improvement and/or maintenance of quality ratings; create and manage project plans to meet established client quality goals
• Drive the client quality strategy for all lines of business (Medicare, Medicaid, Commercial/HIM); serve as primary point of contact and subject matter expert on all quality matters pertaining to assigned clients and area of focus
• Collaborate with key internal and external stakeholders, including Prime's clients, client engagement and clinical functions and external vendors, to ensure needs are understood, capabilities are aligned, and initiatives are on schedule and within budget
• Lead monthly client meetings to review quality reporting and status of strategic plan implementation, and discuss other capabilities, tools or products that could address issues
• Lead monthly internal work groups based on area of focus including reporting, issue management and strategic direction related to quality
• Understand quality compliance and the internal and external factors which impact client quality strategy
• Work cross-functionally to identify and guide improvement in tools, capabilities, products or data that would help clients to improve quality ratings
• Build external client satisfaction by establishing client-facing relationships with health plan quality leaders and successfully implementing quality initiatives
• Other duties as assigned
  
  

Education & Experience

• Bachelor's degree in business administration or related area of study, or equivalent combination of education and/or relevant work experience; HS diploma or GED is required
• 5 years of work experience in managed care or Pharmacy Benefit Management, in client engagement, compliance/regulatory, project management, quality improvement and/or business analysis roles
• Must be eligible to work in the United States without need for work visa or residency sponsorship
  
  

Must be eligible to work in the United States without the need for work visa or residency sponsorship.

Additional Qualifications

• Ability to effectively distill complex information into clear and compelling presentations
• Strong interpersonal skills, with the ability to effectively facilitate meetings, resolve conflict, build consensus, establish rapport and collaborate effectively across departments, internally and externally
• Action-oriented with the ability to identify and assist in implementing opportunities for enhancements
• Organization and prioritization skills, strong attention to detail, and the ability to simultaneously manage multiple projects, under pressure and strict timeframes, without compromising quality
• Strong systems aptitude
  
  

Preferred Qualifications

• Client relationship management experience
• Knowledge of Stars, Medicare Quality programs or QRS
  
  

Physical Demands

• Ability to travel up to 15% of time
• Constantly required to sit, use hands to handle or feel, talk and hear
• Frequently required to reach with hands and arms
• Occasionally required to stand, walk and stoop, kneel, and crouch
• Occasionally required to lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus
  
  

Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures.

Potential pay for this position ranges from $81,000.00 - $138,000.00 based on experience and skills.

To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page and click on the "Benefits at a glance" button for more detail.

Prime Therapeutics LLCis proud to be an equal opportunity and affirmative action employer. We encourage diverse candidates to apply, and all qualified applicants will receive consideration for employment without regard torace, color, religion, gender, sex (pregnancy, sexual orientation, and gender identity), national origin, disability, age, veteran status, or any other legally protected class under federal, state, or local law.

We welcome people of different backgrounds, experiences, abilities, and perspectives including qualified applicants with arrest and conviction records and any qualified applicants requiring reasonable accommodations in accordance with the law.

Prime Therapeutics LLC is a Tobacco-Free Workplace employer.

Positions will be posted for a minimum of five consecutive workdays.

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Quality Assurance

• Industries

  Hospitals and Health Care, Insurance, and Pharmaceutical Manufacturing

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