Clinical Program Development Manager

Elevance Health; Town of Florida (NY); Hybrid; USD 90,000 - 130,000; Full time

Job summary

Elevance Health is seeking a Clinical Program Development Manager to lead population-based clinical quality measures and Medicare Star initiatives within a clinical area and across lines of business. This hybrid role concentrates on program development, cross-functional collaboration, and ensuring regulatory compliance.

The position requires a BA/BS with 5+ years in healthcare data analysis and program development, plus strong vendor management and CMS knowledge.

Qualifications

• 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.
• Experience with CMS regulations related to CMS Star Ratings is preferred.

Responsibilities

• 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.

Skills

AI prompts design

Member experience improvement

Analytical skills

Vendor management

CMS regulations knowledge

Education

BA/BS in business, public health, nursing, epidemiology/biostatistics or related field

Job description

Anticipated End Date

2026-08-28

Position Title

Clinical Program Development Manager

Job Description

Title : 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. 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.

Be Part of an Extraordinary Team

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.

Build the Possibilities. Make an Extraordinary Impact.

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.

How you will make an impact

Primary duties may include, but are not limited to:

• 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
• Experiencein 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 managingmember 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