HEDIS Quality Program Manager

Elevance Health • Tampa, FL

2d • Hybrid

About The Position

The Quality Program Manager (HEDIS) 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. Location: Hybrid: This role requires associates to be in-office 1 - 2 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. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law. How you will make an impact: 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.

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.

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

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

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