Clinical Quality Program Manager

3 weeks ago


Tampa, Florida, United States Elevance Health Full time

About the Role:

The Clinical Quality Program Manager will serve as a liaison with and oversee the quality improvement activities/projects/programs for one or more states within a major line of business. This role will lead state level quality strategy meetings, develop a quality plan, and ensure integration of quality into the overall business process.

Key Responsibilities:

  • Leads state level quality strategy meetings and develops a quality plan
  • 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 research programs to meet regulatory and Accreditation Standards
  • 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
  • Oversees the implementation of new initiatives and leads interactions with regulators or oversight entities
  • Oversees quality improvement activities for the largest, most complex state programs

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
  • HEDIS experience highly preferred
  • Managed care experience highly preferred
  • EPSDT experience highly preferred
  • Quality background highly 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:

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.

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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