Clinical Quality Program Director

5 days ago

Miami, Florida, United States Elevance Health Full time

Clinical Quality Program Administrator Job Description

We are seeking a highly skilled Clinical Quality Program Administrator to join our team at Elevance Health. As a Clinical Quality Program Administrator, you will be responsible for overseeing the quality improvement activities/projects as outlined in the Quality Improvement (QI) work plan and as required by applicable law, regulations and accreditation standards.

Key Responsibilities:

  • Ensures integration of quality into the overall business process.
  • Performs assessments to identify gaps in the enterprises quality and technology assessment processes and initiates actions to correct these gaps.
  • Assures accuracy and completeness of input provided to internal and external QI committees and timely implementation of appropriate interventions.
  • Oversees the clinical quality improvement activities/projects to implement appropriate clinical interventions to improve the quality of care for members.
  • Assures compliance with corporate QI work plans.
  • Assures QI activities are relevant to the targeted population.
  • Assures compliance to Practice Guideline, Delegation and Continuity and Coordination of care Standards.
  • Maintains documentation of research programs to meet regulatory and Accreditation Standards.
  • Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of results.
  • May provide oversight to the Healthcare Effectiveness Data and Information Set (HEDIS) project team.

Requirements:

  • Requires a BS in health administration, nursing or related clinical field; 3 years of health care quality or data analysis experience; or any combination of education and experience, which would provide an equivalent background.
  • Preferred Skills, Capabilities and Experiences:
    • Current unrestricted license or certification in applicable field preferred (i.e. CPHQ).
    • MS in the health field (i.e. Nursing) preferred.
    • Florida Medicaid plan experience highly preferred.
    • MCO (Managed Care Organization) experience preferred.

About Elevance Health

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.

Our Culture

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.

Our Benefits

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.

Hybrid Workforce Strategy

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.

Equal Employment Opportunity

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.

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