Clinical Quality Program Manager

Elevance Health•Columbus, NH

2d•Remote

About The Position

The Clinical Quality Program Manager is 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. This is an Individual Contributor Role. This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. A proud member of the Elevance Health family of companies, Carelon Behavioral Health uses our powerful combination of experience, expertise, dedication and compassion to see what's possible and what's better. Born out of one of the largest healthcare systems organization in the United States, our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges.

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.
Current, unrestricted license related to the medical or behavioral health field, certification in applicable field (i.e. CPHQ).

Nice To Haves

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.

Responsibilities

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