Clinical Program Manager Jobs

Medica’s Clinical Program Manager works to support our Provider partners through timely and accurate program management in support of the Medica Provider Quality Program. Our Program Manager serves as a subject matter expert and provides guidance to Provider partners on clinical data measures that support HEDIS and other quality measures and ensures that data in file feeds will pass external audits.

Key Accountabilities:

• Communicates regularly with key stakeholders in Enterprise Analytics and Network Management to ensure alignment.
• Provides subject matter expertise to internal and external customers on clinical data elements required in data feeds to support the overall Quality Program.
• Collaborates with internal teams to identify quality goals and priorities and establish business owners.
• Works independently on assigned tasks, problem solving for issues and following through with Director of Quality Analytics & Improvement on solutions.
• Provides meeting support and facilitation to ensure timely decision making, consensus building, meeting summaries and next steps with committee stakeholders and others at all levels of leadership.
• Works with internal teams to establish, communicate and negotiate deadlines on data deliverables.
• Presents updates and provides education to internal and external customers based on changes to the metrics that impact the overall program.
• Partners with Clinical Review team to review Data Files submitted by Provider partners for accuracy following established NCQA guidelines for HEDIS and other measures as defined and assigned. Presents findings to Provider partners in a clear, collaborative manner.
• Creates standard work documents and processes.
• Follows standard processes for follow up on identified data issues both with internal and external customers.
• Work with internal teams on identifying data issues/trends and developing standards/solutions.

Qualifications:

• Bachelor’s degree or equivalent combination of education and work experience
• Experience working with HEDIS® and other clinical data measures preferred; other experience related to working with clinical quality measures will also be considered
• 5+ years of relevant experience, including project and/or program management experience

 Skills and Abilities:

• Self-Management skills
• Attention to detail
• Concise communications
• Negotiation skills
• Project management skills
• Presentation skills

Medica's commitment to diversity, equity and inclusion (DEI) includes unifying our workforce through learning and development, recruitment and retention. We consistently communicate the importance of DEI, celebrate achievements, and seek out community partnerships and diverse suppliers that are representative of everyone in our community. We are developing sustainable programs and investing time, talent and resources to ensure that we are living our values. We are an Equal Opportunity/Affirmative Action employer, where all qualified candidates receive consideration for employment indiscriminate of race, religion, ethnicity, national origin, citizenship, gender, gender identity, sexual orientation, age, veteran status, disability, genetic information, or any other protected characteristic.