Clinical Quality Program Lead — Hybrid, HEDIS Focus

Elevance Health; Mason (OH); Hybrid; USD 86,000 - 129,000; Full time

Benefits offered by this job

Benefits package

Equity stock purchase plan

401k contribution

Job summary

Elevance Health in Columbus, OH is seeking a Clinical Quality Program Manager to oversee quality improvement activities across one or more states within a major line of business. This individual contributor role requires a current license or certification in the clinical field and a Monday–Friday schedule with hybrid in-office expectations.

The role partners with Analytics to interpret HEDIS data and drive coordinated quality initiatives, ensuring regulatory and accreditation standards are met

Qualifications

• 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.
• Current, unrestricted license related to the medical or behavioral health field, or certification in applicable field (i.e. CPHQ).

Responsibilities

• Participates in quality strategy activities and leads assigned quality improvement initiatives, ensuring integration of improvement activities into the overall business process.
• Leads root cause analyses to identify drivers of HEDIS performance gaps and develops data-informed recommendations and intervention strategies.
• 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.
• Partners with Analytics and cross-functional stakeholders to develop reporting, interpret HEDIS data, and identify opportunities for quality improvement.
• Oversees the implementation of new initiatives.
• Leads interactions with regulators or oversight entities.
• Oversees quality improvement activities for the largest, most complex state programs.

Skills

Root cause analysis

Data analysis

Quality improvement

HEDIS knowledge

Regulatory documentation

Education

BS in health administration, nursing, or related clinical field

Job description

Elevance Health in Columbus, OH is seeking a Clinical Quality Program Manager to oversee quality improvement activities across one or more states within a major line of business. This individual contributor role requires a current license or certification in the clinical field and a Monday–Friday schedule with hybrid in-office expectations.

The role partners with Analytics to interpret HEDIS data and drive coordinated quality initiatives, ensuring regulatory and accreditation standards are met