Medicaid Quality Management Director
Elevance Health

Job Info

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Medicaid Quality Management Director

Location: This position will work a hybrid model (remote and office). The candidate must live within 50 miles of the Buffalo, NY Elevance Health location.

Build the Possibilities. Make an extraordinary impact.

Responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan. Responsible for working with the regional head of quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement, NCQA accreditation and compliance with regulatory agencies and other objectives.

How you will make an impact:

• Works with both internal and external customers to promote understanding of quality management activities and objectives within the company and to prioritize departmental projects according to corporate, regional, and departmental goals.
  
• Maintains expert knowledge of current industry standards, quality improvement activities, and strong medical management skills.
  
• Serves as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements.
  
• Collaborates with other leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans, year-round medical record review, and over read processes.
  
• Monitors and reports quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements.
  

Minimum Requirements:

• Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and a minimum 5 years progressively responsible experience in a health care environment or any combination of education and experience, which would provide an equivalent background.
  

Preferred Qualifications:

• MS or advanced degree in a health care related field (i.e. nursing, health education) or business strongly preferred.
  
• Previous experience working with QARR, NCQA, and HEDIS within the state of NY strongly preferred.
  
• Experience navigating within a highly matrixed organization.
  

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $110,560 to $165,840.

Locations: New York.

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

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