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