Clinical Quality Program Manager

Elevance Health•Tampa, FL

4d•Hybrid

About The Position

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 position will primarily support Accreditation readiness activities and serve as a key quality partner in ensuring ongoing compliance with Accreditation standards, with a strong emphasis on NCQA Accreditation requirements, regulatory expectations, and continuous quality improvement.

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

Strong knowledge of NCQA Accreditation standards, accreditation survey processes, quality management principles, and healthcare regulatory requirements is strongly preferred.
Candidates should possess exceptional organizational, project management, and communication skills, with demonstrated ability to manage multiple priorities, coordinate across diverse stakeholder groups, and drive complex initiatives to successful completion.
Experience leading cross-functional teams and facilitating process improvement efforts in support of Accreditation readiness is highly desirable.
Current unrestricted license, certification in applicable field (i.e., CPHQ) and/or an MS in the health field (i.e., Nursing) is preferred.

Responsibilities

Leads state level quality strategy meetings, develops a quality plan, and ensures integration of quality into the overall business process.
Serves as a subject matter expert and quality lead for Accreditation readiness efforts, including interpretation, implementation, monitoring, and documentation of NCQA Accreditation standards and requirements.
Partners with business leaders and cross-functional teams to establish, track, and achieve Accreditation-related milestones, deliverables, and readiness activities.
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.
Coordinates and organizes Accreditation work plans, evidence collection, gap assessments, and readiness reviews to support successful Accreditation submissions and surveys.
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.
Collaborates effectively with operational, clinical, compliance, accreditation, and business partners to drive process improvements, strengthen quality outcomes, and support Accreditation performance goals.
Leads interactions with regulators or oversight entities.
Oversees quality improvement activities for the largest, most complex state programs.
Identifies opportunities to improve processes, workflows, documentation practices, and operational controls to enhance organizational readiness and maintain compliance with Accreditation standards.
Develops and delivers education, guidance, and consultation to stakeholders regarding Accreditation requirements, quality standards, and readiness expectations.