Anticipated End Date:

2024-12-24

Position Title:

Manager Clinical Quality

Job Description:

Location: Atlanta GA, Indianapolis IN, Mason OH

Hours: Monday - Friday

Travel: Hybrid (1-2 days onsite)

Position Overview:

Responsible for managing the day-to-day activities of one or more clinical quality program components which may be related to HEDIS reporting, NCQA accreditation and/or other quality assurance related activities.

How You Will Make an Impact:

• Implements and evaluates current processes including operational statistics, service standards and process improvement initiatives

• Provides oversight in the planning, implementation and coordination of health care audits to ensure high quality, cost effective care

• Participates in internal and external quality review activities

• Manages and oversees quality assurance activities, which may include, but is not limited to: managing the production, analysis, and submission of the annual HEDIS report; coordinating audit activities with other regions; managing achievement and maintenance of NCQA accreditation; scheduling all information for surveys, conducting mock audits, and providing consultation to business units and team leads as regards NCQA standard issues

• Analyzing and managing hospital chart reviews and inquiries

• Hires, trains, coaches, counsels, and evaluates performance of direct reports

Required Qualifications:

• Requires BS in nursing or a health care related field and minimum of 3 years of managed care experience which includes a minimum of 2 years supervisory experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications:

• Active Nursing license is a must

• Expertise in HEDIS transitions of care is a must

• Experience in program development and knowledge of the quality process and QI techniques strongly preferred

• Previous HEDIS audit experience preferred

• Previous healthcare manager experience preferred

Job Level:

Manager

Workshift:

1st Shift (United States of America)

Job Family:

MED > Licensed/Certified - Other

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.