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SalaryOur 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 Star Ratings - Remote Job Description
The 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
Minimum Qualifications
- 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
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
Minimum Physical Job Requirements
- 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
Reporting Structure
- Reports to a Senior Director in the Quality Management department
Prime Therapeutics LLC is an Equal Opportunity Employer. We encourage diverse candidates to apply and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, genetic information, marital status, family status, national origin, age, disability, veteran status, or any other legally protected class under federal, state, or local law.
Positions will be posted for a minimum of five consecutive workdays.
