Clinical Quality Program Manager

Elevance Health • Walnut Creek, CA

3d • Hybrid

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 role requires associates to be in-office 1 day 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. Internal candidates may be considered with a confirmed virtual exception on file. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

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.

Nice To Haves

• Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.
• Experience with NCQA and HEDIS strongly preferred
• Knowledge of DMHC and/or DHCS health plan regulations strongly preferred

Responsibilities

• Leads state level quality strategy meetings, develops a quality plan, and ensures integration of quality into the overall business process.
• Works with the clinical intervention team to design studies to identify barriers to medical interventions.
• 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.
• 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 initiatives.
• Leads interactions with regulators or oversight entities.
• Oversees quality improvement activities for the largest, most complex state programs.

Benefits

• a comprehensive benefits package
• incentive and recognition programs
• equity stock purchase
• 401k contribution
• merit increases
• paid holidays
• Paid Time Off
• incentive bonus programs
• medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level