Clinical Quality Program Director – Next Generation MyCare Ohio

Elevance Health•Columbus, OH

2d•Hybrid

About The Position

The Clinical Quality Program Director is responsible for leading quality improvement strategy and program implementation for the Next Generation MyCare Ohio program, driving performance improvement initiatives, regulatory compliance, quality outcomes, and cross-functional collaboration to support Medicare and Medicaid populations within a highly regulated managed care environment. This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. For candidates working in person or virtually in the below location(s), the salary range for this specific position is $112,800 to $169,200. Location: Columbus, OH

Requirements

Requires a BS in health administration, nursing or a related clinical field; 5 years of health care quality or data analysis experience; or an equivalent combination of education and experience, which would provide an equivalent background.

Nice To Haves

Current unrestricted RN license, applicable clinical licensure, Certified Professional in Healthcare Quality (CPHQ), or Master's degree in Nursing, Healthcare Administration, Public Health, or a related healthcare discipline preferred.
Experience leading quality management, quality improvement, HEDIS, STARs, or healthcare performance measurement initiatives within a managed care, Medicaid, Medicare, or health plan environment preferred.
Strong knowledge of Medicaid, Medicare, Dual Eligible, Next Generation MyCare Ohio, or other integrated care program populations preferred.
Experience interpreting state contracts, regulatory requirements, accreditation standards, and compliance expectations within a regulated healthcare environment preferred.
Demonstrated expertise in quantitative and qualitative data analysis, root cause analysis, performance improvement planning, and driving measurable quality outcomes preferred.
Proven ability to lead cross-functional quality initiatives, facilitate executive-level discussions, and partner effectively with health plan leadership, provider organizations, and enterprise stakeholders preferred.

Responsibilities

Leads quality strategy meetings and serves as a subject matter expert for the MyCare Ohio program, partnering with health plan leadership, enterprise quality teams, and state stakeholders to advance program goals.
Develops and facilitates the integration of quality improvement strategies, workplans, and initiatives that support MyCare Ohio quality measures and contractual requirements.
Identifies and integrates best practices, quality interventions, and performance improvement opportunities that drive measurable improvements in quality outcomes and member care.
Develops performance improvement plans and oversees quality improvement activities, including monitoring HEDIS and other quality measures, analyzing trends, and implementing corrective strategies.
Participates in the development, management, review, and reporting of program outcomes, quality initiatives, regulatory requirements, and performance metrics.
Assures compliance with corporate Quality Improvement workplans, state contract requirements, regulatory standards, and program governance requirements.
Oversees annual quality program documentation, including program descriptions, workplans, evaluations, and other required regulatory submissions.
Assures accurate and complete quantitative and qualitative analysis of clinical and quality performance data, including root cause analysis and identification of improvement opportunities.
Leads department projects, facilitates quality governance committees, and collaborates across provider, population health, utilization management, and enterprise quality functions.
Prepares and presents quality program updates, performance results, and strategic recommendations to senior leadership and external stakeholders.