Behavioral Health Clinical Qual Prog Manager

4 weeks ago

Chicago, 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 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

Minimum Requirements:

  • 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.

Preferred Skills, Capabilities and Experiences:

  • 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 expertise -- ability to execute with excellence independently.

  • Experience with and knowledge of NCQA MBHO Accreditation standards.

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