Program Manager, Medicare Stars (Provider Performance)

Mosaic Health, LLC.; California (MO); Remote; USD 98,000 - 148,000; Full time

Job summary

Mosaic Health is seeking a Program Manager for Medicare Stars to optimize quality performance among providers. This key role involves analyzing provider data, leading reviews, and collaborating on initiatives to enhance care quality and patient outcomes within a remote work environment.

Qualifications

• Minimum 3 years of experience with Medicare Stars, HEDIS, and/or Quality Improvement.
• Minimum 3 years of experience working directly with clinicians.

Responsibilities

• Analyze provider performance data to identify trends and opportunities for improvement.
• Lead performance reviews and guide clinicians in implementing clinical improvements.
• Manage initiatives that enhance provider performance across all Medicare contracts.

Skills

Analytical skills

Problem solving

Communication skills

Education

Bachelor’s degree in a health-related field

Job description

Program Manager, Medicare Stars (Provider Performance) page is loaded

Program Manager, Medicare Stars (Provider Performance)

Apply remote type Remote - Full Time locations California, USA Nevada, USA Arizona, USA time type Full time posted on Posted 8 Days Ago job requisition id M10607

Job Description Summary

The Program Manager, Medicare Stars (Provider Performance) plays a critical role within the Carelon Health Quality Improvement Department. This individual is responsible for optimizing quality performance among employed providers and clinic teams to ensure efficient, effective patient care while supporting enterprise-wide Medicare Star goals.

How will you make an impact & Requirements

Key Responsibilities:

• Analyze provider performance data to identify trends, discrepancies, and opportunities for improvement.

• Lead performance reviews with individual providers; guide clinicians in interpreting metrics and implementing clinical and operational improvements.

• Assess and resolve operational barriers impacting provider performance; drive targeted performance initiatives in collaboration with key stakeholders.

• Provide Medical Officers with regular performance updates to maintain transparency and alignment with organizational objectives.

• Manage initiatives that enhance provider performance across all Medicare contracts, ensuring measurable and meaningful results.

• Collaborate cross-functionally to identify and overcome roadblocks to performance improvement.

• Serve as a subject matter expert on Medicare Stars, maintaining up-to-date knowledge of CMS regulations and requirements.

• Promote a culture of service excellence and embody company core values to enhance patient care and outcomes.

• Support business strategy through a portfolio of integrated cross-functional and provider-facing projects.

• Represent the Quality Improvement Department in clinical and quality-related discussions.

• Perform additional duties as assigned.

Qualifications:

• Bachelor’s degree in a health-related field, or an equivalent combination of education and experience

• Minimum 3 years of experience with Medicare Stars, HEDIS, and/or Quality Improvement

• Minimum 3 years of experience working directly with clinicians

Preferred Skills & Experience:

• Experience in outpatient or ambulatory settings working with clinicians and clinic teams.

• Strong analytical and problem-solving skills, including proficiency with data analysis and reporting tools.

• Excellent presentation and communication skills, with the ability to clearly convey performance insights and improvement strategies.

• Demonstrated success in building strong working relationships, leading teams in a matrixed environment, and resolving complex issues.

• Proven ability to foster collaboration, influence across functions, and communicate effectively at all organizational levels.

Compensation: $98,032K - $147,048K & bonus eligible

About Us

Mosaic Health: Who we are

Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. The Business Units which comprise Mosaic Health are multi-payer and serve nearly one million consumers across 19 states, providing them with access to high quality primary care, integrated care teams, personalized navigation, expanded digital access, and specialized services for higher-need populations. Through Mosaic Health, health plans and employers have an even stronger care provider partner that delivers affordability and superior experiences for their members and employees, including value-based primary care capacity integrated with digital patient engagement and navigation. Each of the companies within Mosaic Health provide unique offerings that together promise to improve individuals' health and wellbeing, while helping care providers deliver higher quality care. For more information, please visit www.mosaichealth.com or follow Mosaic Health on LinkedIn .

Mosaic Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws.

If you require an accommodation for the application or interview process, please let us know and we will work with you to meet your needs.Please contact [e-mail] for assistance.