Program Manager, Medicare Stars (Provider Performance)

Job Description:

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.

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.