Healthcare Program Specialist (Bilingual Chinese or Vietnamese)

Job DetailsJob Location: Huntington Beach Office - Huntington Beach, CA 92647Position Type: Full TimeSalary Range: $72,800.00 - $80,000.00 SalaryAre you ready to make a lasting impact and transform the healthcare space? We are one of Southern California’s fastest-growing Medicare Advantage plans with an incredible 112% year-over-year membership growth.   

Who Are We? ✨ 

Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values. 

Why Join Us? 🏆 

We’re on a mission! Our rapid growth reflects our commitment to making healthcare accessible for underserved communities. At Clever Care, you’ll have the opportunity to make a real difference, shape the future of healthcare, and be part of a fast-moving, game-changing organization that celebrates diversity and innovation. 

Job Summary

The Star Programs Specialist is responsible for assisting with the deployment and implementation of member experience improvement strategies, collecting and tracking member feedback from all channels in the organization. The Star Programs Specialist will also work closely with Network / Provider Relations Team for continuous training and education on CAHPS measures under the CMS Star Programs and Customer Service Team to resolve member related incidents.

Functions & Job Responsibilities

• Engage providers through a focused, meaningful, educational approaches to proactively address member abrasion points

• Drive providers to take an active role with the Clever Care Health Plan's quality improvement programs, and various health-centered incentives

• Support process improvement in collaboration with management efforts

• Collaborate with Customer Service Team and work to resolve escalated member incidents pertaining to Access to care, vendor, Rx and other issues.

• Facilitate fax or telephone call notification for providers targeted Stars measures

• Create PowerPoint decks and other training materials for providers and staff.

• Monitors and ensures that key Stars/CAHPS activities are completed on time and accurately in order to present results to key departmental management and other Clever Care departments as needed.

• Collects and compiles the required documentation to maintain critical quality improvement functions.

• Participate in Stars activities, meetings, and discussions with and between other departments within the organization and or PCP’s, IPA’s and MSO’s.

• Assist in evaluating project/program activities and results to identify opportunities for improvement.

• Surfaces to Director any gaps in processes that may require remediation.

• Other duties as assigned
QualificationsQualifications

Education and Experience:

· Bachelor's Degree or equivalent combination of education and work experience.

· Minimum three (3) years' experience in Healthcare

· Minimum two (2) years' experience in health plan quality improvement, managed care or equivalent experience.

· Knowledge of CMS Star Programs, HEDIS, CAHPS

· Valid driver’s license, reliable transportation, and insurance required with clean driving record

Skills:

· Team player, leader, and individual contributor who can engage relevant parties cross-functionally, drive decision making, and as applicable, facilitate operational change.

· Proven track record of success implementing provider outreach and educational programs and/or projects and must be able to think critically to analyze performance and identify opportunities for improvement.

· Demonstrated solid business writing experience.

· Prior experience with project coordination and timelines

· Demonstrated effective organizational skills.

· Excellent communication, writing, proofreading and grammar skills

· Strong proficiency with MS Word, Excel, Power Point

· Excellent organizational skills and attention to detail

· Ability to interact with all levels of the organization, as well as external stakeholders.

· Superior meeting facilitation skills

· Knowledge of HEDIS technical requirements.

· Understanding of CMS 5 Star program and requirements.

Other:

· Willing to travel locally to provider offices

Wage Range: $72,800 to $80,000 per year

Physical & Working Environment.

Physical requirements needed to perform the essential functions of the job, with or without reasonable accommodation:

• Must be able to travel when needed or required

• Ability to operate a keyboard, mouse, phone and perform repetitive motion (keyboard); writing (note-taking)

• Ability to sit for long periods; stand, sit, reach, bend, lift up to fifteen (15) lbs.

 

Ability to express or exchange ideas to impart information to the public and to convey detailed instructions to staff accurately and quickly.

 

Work is performed in an office