Behavioral Health HEDIS Quality Program Manager

2 months ago

Woburn, Massachusetts, United States Elevance Health Full time

Location: Within 50 miles of one of our Eastern Time Zone Elevance Health Pulse Points

Shift: Monday - Friday; 8:00am - 5:00pm ET

The Behavioral Health HEDIS Quality Program Manager is responsible for serving as the quality lead and overseeing the quality improvement activities/projects/programs for one or more health plans within a major line of business.

How you will make an impact:

  • Leads plan level HEDIS strategy to drive improvement in behavioral health HEDIS measures, ensuring achievement in performance guarantees and/or service level agreements
  • Leads plan 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 programs to meet regulatory and Accreditation Standards.
  • Provides oversight to assure accurate and complete quantitative and qualitative 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 and project manages the implementation of new initiatives.
  • Leads interactions with regulators or oversight entities.

Minimum 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.

Preferred skills, experiences, and capabilities:

  • Current unrestricted license, certification in applicable field (ie CPHQ) and/or a MS in the health field (ie Nursing) is preferred.

For candidates working in person or remotely in the below locations, the salary range for this specific position is $83,748 to $143,568.

Locations: New York; Jersey City, NJ

In addition to your salary, 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). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

  • The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

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