Offer summary

Qualifications:

Bachelor's degree in business administration or related field, or equivalent experience., 5 years of experience in managed care, client engagement, compliance, or quality improvement roles., Strong interpersonal skills and ability to facilitate meetings and build consensus., Knowledge of Medicare Stars, Medicaid quality, and quality rating systems is preferred..

Key responsibilities:

Ensure successful planning and execution of quality initiatives for assigned clients.

Analyze quality data and recommend strategies for improvement of quality ratings.

Collaborate with internal and external stakeholders to align capabilities and initiatives.

Lead client meetings to review quality reporting and discuss strategic plan implementation.

Job description

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 LLC is 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 to race, 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.

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