Clinical Quality Program Manager

JR131500 Clinical Quality Program Manager

Responsible for serving as a liaison with and overseeing the quality improvement activities/projects/programs for one or more states within a major line of business.

Location: This position will work a hybrid model (remote and office) and must live within 50 miles of one of our Pulse Point office locations in Florida.

How will you make an impact:

Leads plan level HEDIS strategy to drive improvement in behavioral health HEDIS measures, ensuring achievement in performance guarantees and/or service level agreements.

Leads stakeholder advisory committees.

Leads plan level quality strategy meetings, develops a quality plan, and ensures integration of quality into the overall business process.

Works with the clinical intervention team to design studies to identify barriers to medical interventions.

Ensures that study methodology is sound and appropriate reporting is in place.

Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of care for members.

Assures compliance with corporate QI work plans.

Assures that all QI activities are relevant to the needs of targeted population.

Maintains effective documentation of programs to meet regulatory and Accreditation Standards.

Provides oversight to assure accurate and complete quantitative and qualitative analysis of clinical data and presentation of data analysis results.

Participates in and provides input to the development of new product designs for major line of business. Oversees and project manages the implementation of new initiatives.

Leads interactions with regulators or oversight entities.

Oversees quality improvement activities for the largest, most complex plan programs.

Minimum requirements:

Requires a BS in health administration, nursing, or a related clinical field; 4 years of health care quality or data analysis experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities, and Experiences:

Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success – for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance.