Medicaid Quality Management Health Plan Director

Elevance Health • Cincinnati, OH

2d • Hybrid

About The Position

Medicaid Quality Management Health Plan Director Location: 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. 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 an accommodation is granted as required by law. The Medicaid Quality Management Health Plan Director is responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan. Responsible for working with the regional head of quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement, NCQA accreditation and compliance with regulatory agencies and other objectives. How you make an impact: Works with both internal and external customers to promote understanding of quality management activities and objectives within the company and to prioritize departmental projects according to corporate, regional, and departmental goals. Maintains expert knowledge of current industry standards, quality improvement activities, and strong medical management skills. Serves as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements. Collaborates with other leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans, year-round medical record review, and over read processes. Monitors and reports quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements.

Requirements

• Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and a minimum 5 year progressively responsible experience in a health care environment or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

• Knowledge and experience with Ohio Department of Medicaid’s Quality Withhold Programs strongly preferred.
• Extensive knowledge of Ohio Department of Medicaid’s Quality expectations strongly preferred.
• Proven experience utilizing data analysis to drive quality improvement initiatives strongly preferred.
• Proven experience leading providers, community partners, and shareholders in initiatives to close gaps in HEDIs rates strongly preferred.
• Experience effectively deploying quality tools ex. Key Driver Diagrams, Fishbone, Voice of Customer, Run Charts etc. is a plus.

Responsibilities

• Driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan.
• Directing the clinical quality initiatives, including HEDIS and CAHPS quality improvement, NCQA accreditation and compliance with regulatory agencies and other objectives.
• Promoting understanding of quality management activities and objectives within the company and to prioritize departmental projects according to corporate, regional, and departmental goals.
• Serving as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements.
• Collaborating with other leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans, year-round medical record review, and over read processes.
• Monitoring and reporting quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements.

Benefits

• Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• 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: Director