Note: The job is a remote job and is open to candidates in USA. Elevance Health is a health company dedicated to improving lives and communities by simplifying healthcare. The Clinical Quality Program Manager serves as a liaison and oversees quality improvement activities, projects, and programs for one or more states within a major line of business. The role leads HEDIS performance analysis, develops improvement strategies, ensures regulatory compliance, and partners with analytics and cross-functional stakeholders to improve care quality.
Responsibilities
- Participates in quality strategy activities and leads assigned quality improvement initiatives, ensuring integration of improvement activities into the overall business process
- Leads root cause analyses to identify drivers of HEDIS performance gaps and develops data-informed recommendations and intervention strategies
- 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 research programs to meet regulatory and Accreditation Standards
- Partners with Analytics and cross-functional stakeholders to develop reporting, interpret HEDIS data, and identify opportunities for quality improvement
- Oversees the implementation of new initiatives
- Leads interactions with regulators or oversight entities
- Oversees quality improvement activities for the largest, most complex state programs
Skills
- 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
- Current, unrestricted license related to the medical or behavioral health field, certification in applicable field (i.e. CPHQ)
- MS in the health field (i.e. Nursing) is preferred
- HEDIS knowledge and experience supporting HEDIS quality improvement initiatives highly preferred
- Experience interpreting healthcare quality data to identify trends, root causes, and improvement opportunities preferred
Benefits
- This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy.
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs (unless covered by a collective bargaining agreement)
- Medical benefits
- Dental benefits
- Vision benefits
- Short term disability benefits
- Long term disability benefits
- 401(k) +match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
Company Overview
Company H1B Sponsorship