Senior Manager, Stars and Clinical Initiatives

Job Summary

The Senior Manager, Stars and Clinical Initiatives is responsible for developing and managing improvement programs for Dual Eligible Special Needs Plan (D-SNP) and Covered California lines of business to elevate Stars performance. The focus is to achieve higher Star ratings by driving sustained improvement in clinical quality, member experience, pharmacy performance, and operations. As a key cross-functional leader, the Senior Manager will collaborate across departments to develop and execute best practices for continuous improvement of Stars and member outcomes. This position will also include identifying and managing federal and state D-SNP and Covered California Star program regulatory updates and risks to help ensure compliance and continued high performance. 

Manage all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.  Responsible for driving management and performance to ensure that the team can lead high-level decisions that impact on the success of L.A. Care.  Oversee the development, implementation, administration, and maintenance of the department's programs, policies, and procedures.

Collaborate closely with executive/ senior management to establish goals that align with the company’s mission and vision.

Duties

Lead the development, implementation, and continuous improvement of clinical and quality improvement programs that support D-SNP and Covered California Star performance.

Collaborate closely and build cross-functional alignment with internal teams to develop and implement evidence-based best practices. 

Serve as Medicare and Covered California Stars subject matter expert and strategic thinker while also being a hands-on, operational and execution-focused leader. 

Analyze data, distill actional insights, and incorporate into program evaluations and data-driven continuous improvement strategies. Deliver reports to required committees and workgroups.

Stay updated on industry trends and best practices including around the application of Artificial Intelligence (AI) tools to improve quality of care, member experience, and member outcomes. Support the adoption of new technology and innovation to elevate Stars performance and member outcomes.

Engage with external stakeholders including vendors, community organizations, and other solution providers to build new partnerships that elevate Stars performance and services for members.

Identify and manage Centers for Medicare and Medicaid Services (CMS) and state regulatory updates and risks to ensure compliance with standards. Execute risk mitigation activities.

Manage staff and day-to-day activities in the department. Participate in the department budgeting process.  Responsible for scheduling, training, performance, corrective actions, mentoring, and developing of the team(s). 

Foster and promote a culture of transparency, continuous improvement, accountability, and shared ownership of enterprise goals. Mentor and develop staff, building technical and problem-solving skills across the team.

Implement and provide guidance to the departmental and organizational processes and policies and work with senior and/or executive management to define, prioritize, and develop projects and programs.

Responsible for identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.

Responsible for overseeing and managing the budgets of their respective departments.

Manage complex projects, engage and update key stakeholders, develop timelines, lead others to complete deliverables on time and ensure implementation upon approval.

Plan and implement systems and procedures to maximize operating efficiency and achieve strategic priorities. 

Duties Continued

Support Medi-Cal and Personal Assistance Services Council-Service Employees International Union (PASC-SEIU) improvement initiatives as needed.

Perform other duties as assigned.

Education Required

Education Preferred

Experience

Required:
At least 7 years of Medicare Stars experience including experience driving measurable improvement in quality metrics and Star ratings within a health plan.

At least 5 years of leadership experience with proven ability to motivate and develop team members.

At least 5 years of leading staff, supervisor/management experience.

Experience leading and supporting initiatives aimed at transforming care delivery and improving health outcomes for vulnerable populations through a service-oriented, mission-driven approach.

Experience leading teams, projects, or cross-functional groups.

Skills

Required:

Deep knowledge of Stars, Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPs), and related quality improvement programs.

Strong knowledge of CMS and state regulatory standards and industry trends.

Excellent analytic skills to conduct analysis and develop recommendations with proficiency in Stars data analysis, performance modeling, and reporting.

Ability to work across functions and build strong collaboration and partnership with diverse internal and external stakeholders.

Excellent verbal and written communication skills.

Excellent presentation skills. 

Ability to prioritize multiple and competing tasks and drive projects to successful execution and measurable results.

Proficient with Microsoft Word, Excel, PowerPoint, and Outlook.

Demonstrated agility to embrace new challenges and continuous learning.

Strategic mindset alongside hands-on operational, project management, and execution focus.  

Driven by high motivation, deep conviction, humility to serve, and desire to improve the lives of vulnerable populations.

Strong interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment. Ability to guide and support team members.

Excellent ability to set clear goals, develop strategic plans to achieve those goals, and inspire others to work towards a shared vision.

Skilled in mediating disputes and resolving conflicts in a fair and constructive manner.

Deep understanding of financial principles.

Ability and excellent knowledge in developing and managing budgets, forecasting future financial outcomes, and making informed decisions about resource allocation.

Ability to make informed decisions.

Deep understanding of the industry, market dynamics, and organizational operations to identify opportunities and navigate challenges.

Strong ability and knowledge to analyze market trends, anticipate future changes, and develop long-term strategies that align with the company's goals.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Preferred:

Process improvement training.

Physical Requirements

Additional Information