Manager Clinical Quality (HEDIS)

Elevance Health • Nashville, TN

4d • Hybrid

About The Position

Manager Clinical Quality CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services. LOCATION: This position requires 3 days per week in-office. You must be within a commutable distance of one of our aligned offices. HOURS: General business hours, Monday through Friday. (Core hours: 8-5) Hybrid 2: 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. 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. The Manager Clinical Quality is responsible for managing the day-to-day activities of one or more clinical quality program components which may be related to HEDIS reporting, NCQA accreditation and/or other quality assurance related activities.

Requirements

• Requires BS in nursing or a health care related field and minimum of 3 years of managed care experience which includes a minimum of 2 years supervisory experience; or any combination of education and experience, which would provide an equivalent background.
• Certification and/or license appropriate to field of specialty is required.

Nice To Haves

• Experience in program development and knowledge of the quality process and QI techniques strongly preferred.
• 3+ years of experience in clinical quality (HEDIS/Stars).
• 3+ years of patient-facing experience.
• Strong experience with EMR, medical records, or in patient-facing roles within any healthcare environment.
• Significant experience in clinical data collection, abstraction, or validation.
• Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook)
• Experience with clinical systems such as electronic medical records, care management, or population health management.
• Bilingual skills are very helpful for this role.
• Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Responsibilities

• Implements and evaluates current processes including operational statistics, service standards and process improvement initiatives.
• Provides oversight in the planning, implementation and coordination of health care audits to ensure high quality, cost effective care.
• Participates in internal and external quality review activities.
• Manages and oversees quality assurance activities, which may include, but is not limited to: managing the production, analysis, and submission of the annual HEDIS report; overseeing community health promotion and disease management initiatives in each state in the region; coordinating audit activities with other regions; managing achievement and maintenance of NCQA accreditation; scheduling all information for surveys, conducting mock audits, and providing consultation to business units and team leads as regards NCQA standard issues.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

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: Manager