Clinical Quality Program Manager
Elevance Health

Job Info

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JR130517 Clinical Quality Program Manager

Leads the behavioral health (BH) HEDIS health intervention program for our comprehensive care for people with serious mental illness (CCPSMI) population across multiple markets. Develops HEDIS work plan, metrics monitoring, and supports new HEDIS intervention deployment. Ensures integration of quality into the overall business process and assists in the strategic programming across stakeholder groups.

Location: This position will work in a hybrid model (remote and office) with once a week from the nearest Elevance Health PulsePoint location. The Ideal candidate will live within 50 miles/1 hr. commute of one of our Elevance Health Open PulsePoint locations.

How will you make an impact:

• Develops HEDIS related trainings for clinical and network staff intervention deployment.
  
• Conducts root cause analysis for all measures not meeting target and intervention programs to address deficiencies.
  
• Ensures fidelity of standardized HEDIS interventions through auditing of clinical record.
  
• Facilitates stakeholder workgroups to review data, share best practice, and continue to improve the BH HEDIS intervention program.
  
• Collaborates with reporting/analytics teams on development of leading indicators to demonstrate program effectiveness.
  
• 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 that all QI activities are relevant to the needs of targeted population.
  
• Maintains effective documentation of quality program 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 quality initiatives to support the CCPSMI BH program.
  

Minimum 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.
  

Preferred Skills, Capabilities, and Experiences:

• Background in process/performance improvement, lean six sigma.
  
• Experience in behavioral health care field with Serious Mental Illness (SMI) population.
  
• Expertise in cross-functional leadership.
  
  • Develop new clinical and network interventions to improve BH HEDIS measure performance
    
• Experience in managed care and with BH HEDIS measure improvement at the member, provider and systems level.
  
• Population health, health equity and stratification of data to improve delivery of care
  
• Identification of outcomes measures is necessary.
  

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