Behavioral Health HEDIS Quality Program Director

3 weeks ago

Independence, United States Elevance Health Full time

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 HEDIS Quality Program Director

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 HEDIS Quality Program Director is responsible for leading and implementing enterprise-wide Quality initiatives to improve HEDIS and execute quality strategic priorities across the organization.

How you will make an impact:

  • Develops and facilitates the integration of a national quality plan.

  • Develops performance improvement plans and oversees the clinical quality improvement activities/projects.

  • Participates in the development, management, review and reporting of program outcomes for clinical quality programs.

  • Assures compliance with corporate Quality Improvement work plans.

  • Assures accurate and complete quantitative analysis of clinical data.

  • Leads department projects and mentors staff.

  • Prepares and presents program documents to senior management.

  • Accountable for leading enterprise-wide cross-functional behavioral health HEDIS and other Quality projects across the lifespan, from inception through communication of actionable findings, and provides collaborative guidance and consultation to internal and external partners.

  • Develops detailed project plans, all program documents, workflows and training materials, outcomes reporting, QIAs in compliance with regulatory and accreditation standards

  • Organizational SME for HEDIS programs, intervention deployment, and continuous quality improvement.

  • Implements effective communication plans and change management strategies to facilitate organizational adoption of quality initiatives.

  • Guides strategic efforts with clinical and network to improve experience of care and services of members.

Minimum Requirements:

  • Requires a BS in health administration, nursing or a related clinical field; must have a minimum of 5 years of health care quality or data analysis experience ; or an equivalent combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

  • Current, unrestricted license or certification in an applicable field (i.e. CPHQ) or MS in the health field (i.e. Nursing) preferred.

  • Understanding of MBHO/health plan operations across functional areas strongly preferred.

  • Experience with behavioral health HEDIS and specifically developing and implementing targeted clinical, network, and vendor programs to drive measurable improvements in outcomes and rates highly preferred.

  • Experience developing clinical workflows ensuring outcome reporting during process builds through data warehouse mapping/extraction.

  • Strategic leader with tactical expertise -- ability to execute with excellence independently.

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