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Behavioral Health Clinical Qual Prog Manager
4 months ago
2024-06-20
Position Title:
Behavioral Health Clinical Qual Prog Manager
Job Description:
A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
Behavioral Health Clinical Quality Program Manager
*This is an Individual Contributor Role.*
Location: This position will work a Hybrid Model (remote and office). Ideal candidates Must live within 50 miles or a 1 hour commute to an Elevance Health corporate office.
Work Shift Hours: Monday through Friday, 40 hrs a week.
The Behavioral Health Clinical Quality Program Manager is responsible for developing, implementing, and monitoring Quality initiatives to improve HEDIS and execute quality strategic priorities across the organization in compliance with NCQA MBHO standards.
How you will make an impact:
- Leads cross-departmental workgroups across clinical, provider quality, network, quality, analytics, operations teams to execute on targeted interventions to improve behavioral health HEDIS and other quality outcomes.
- Develops tools, resources, materials, trainings, and materials to guide organizational deployment and documentation of Quality Improvement Activities in accordance with NCQA standards.
- Creates and manages detailed project plans for quality intervention programs, accountable for delivering end-to-end program documentation and monitoring outcomes to evaluate impact
- Accountable for conducting and presenting QIAs across multiple functional areas to be included in accreditation required evaluations and submissions.
- 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.
- Leads large committee and workgroup presentations responsible for identifying improvement opportunities, driving strategy and establishing all documentation from agenda, minutes, summary, and outcomes.
- 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.
- Serve as HEDIS SME to quality and other departments to provide education and guide tactical program development including workflows, SOPs, program summaries, reporting plans
- Guide strategic efforts with clinical and network teams to improve member and provider experience of care and quality outcomes
- Requires a BS in health administration, nursing or a related clinical field; a minimum 4 years of health care quality or data analysis experience; or an equivalent combination of education and experience, which would provide an equivalent background.
- Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.
- Understanding of MBHO/health plan operations across functional areas strongly preferred.
- Experience with behavioral health HEDIS and specifically developing targeted clinical and provider programs to drive measurable improvements in rates highly preferred.
- Experience developing clinical workflows ensuring outcome reporting during process builds through data warehouse mapping/extraction
- Strategic leader with tactical expertiseability to execute with excellence independently.
- Experience with and knowledge of NCQA MBHO Accreditation standards.
Job Level:
Non-Management Exempt
Workshift:
1st Shift (United States of America)
Job Family:
QLT > Clinical Quality
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
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 elevancehealthjobssupport@elevancehealth.com for assistance.
