Anticipated End Date:

2024-11-04

Position Title:

Clinical Quality Program Manager

Job Description:

JR130517 Clinical Quality Program Manager

Leads the behavioral health (BH) HEDIS health intervention program for our comprehensive care for people with serious mental illness (CCPSMI) population across multiple markets.  Develops HEDIS work plan, metrics monitoring, and supports new HEDIS intervention deployment. Ensures integration of quality into the overall business process and assists in the strategic programming across stakeholder groups.

Location: This position will work in a hybrid model (remote and office) with once a week from the nearest Elevance Health PulsePoint location. The Ideal candidate will live within 50 miles/1 hr. commute of one of our Elevance Health Open PulsePoint locations.

How will you make an impact:

• Develops HEDIS related trainings for clinical and network staff intervention deployment.

• Conducts root cause analysis for all measures not meeting target and intervention programs to address deficiencies.

• Ensures fidelity of standardized HEDIS interventions through auditing of clinical record.

• Facilitates stakeholder workgroups to review data, share best practice, and continue to improve the BH HEDIS intervention program. 

• Collaborates with reporting/analytics teams on development of leading indicators to demonstrate program effectiveness.

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

• Maintains effective documentation of quality program to meet regulatory and Accreditation Standards.

• Provides oversight to assure accurate and complete quantitative 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 the implementation of new quality initiatives to support the CCPSMI BH program.

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:

• Background in process/performance improvement, lean six sigma.

• Experience in behavioral health care field with Serious Mental Illness (SMI) population.

• Expertise in cross-functional leadership.

  • Develop new clinical and network interventions to improve BH HEDIS measure performance

• Experience in managed care and with BH HEDIS measure improvement at the member, provider and systems level.

• Population health, health equity and stratification of data to improve delivery of care

• Identification of outcomes measures is necessary.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

QLT > Clinical Quality

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 [email protected] for assistance.