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Medicaid Quality Management Health Plan Director Sr
4 months ago
Medicaid Quality Management Health Plan Director Sr.
Location: This position will work a hybrid model (remote and office) out of the Indianapolis, Indiana office. Applicants should be willing to relocate or currently reside within 50 miles of the Indianapolis office.
The Medicaid Quality Management Health Plan Director Sr. will be responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan. Role intended to be limited to large and complex health plans with multiple HEDIS project and significant value capture dollars at risk. 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. In this senior role, also responsible to assist regional head of quality management to mentor QM Directors of less complex health plans.
How you will make an impact:
- Works with both internal and external customers to promote broad understanding of quality management activities and objectives within the company and to prioritize departmental projects according to corporate, regional, and departmental goals.
- Supports the External Quality Review Organization (EQRO) reporting and state audit processes.
- Provides leadership for QM representation in new business activities.
- 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 enterprise leaders, including staff-VPs and RVPs, 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.
- Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and a minimum 10 years progressively responsible experience in a health care environment or any combination of education and experience, which would provide an equivalent background.
- Medicaid experience strongly preferred.
- MS or advanced degree in a health care related field (nursing, health education) or business strongly preferred
- Previous experience working with NCQA, and HEDIS preferred.
Who We Are
Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
How We Work
At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.
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.
Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact assistance.
