Clinical Quality Program Manager
Elevance Health

Job Info

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Be Part of an Extraordinary Team

Title: Clinical Quality Program Manager

Location: Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location: FL-MIAMI, 11430 NW 20TH ST, STE 300 or FL-TAMPA, 5411 SKY CENTER DR

Shift: Hybrid; in-office 1-2 days/week, WFH 4-5 days/week.

Build the Possibilities. Make an Extraordinary Impact.

The Clinical Quality Program Manager is responsible for serving as a liaison with and overseeing the quality improvement activities/projects/programs for one or more states within a major line of business.

How you will make an impact:

Primary duties may include, but are not limited to:

• Leads state level quality strategy meetings, develops a quality plan, and 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. Leads interactions with regulators or oversight entities.
• Oversees quality improvement activities for the largest, most complex state programs.

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:

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

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