Clinical Quality Program Manager

Elevance Health; Indianapolis (IN); Hybrid; USD 86,000 - 129,000; Full time

Job summary

Elevance Health in Columbus, OH is seeking a Clinical Quality Program Manager to oversee state-based quality improvement activities within a major line of business. This individual contributor role requires collaboration with analytics and regulatory teams to drive improved member care.

The position emphasizes leading HEDIS initiatives, data-driven root cause analyses, and ensuring compliance with corporate QI work plans in a hybrid work environment.

Qualifications

• Requires BS in health administration, nursing, or related clinical field; 4 years health care quality or data analysis experience.
• 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.
• 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 QI activities to improve the quality of care for members.
• Assures compliance with corporate QI work plans.
• Maintains documentation of research programs to meet regulatory and Accreditation Standards.
• Partners with Analytics and cross-functional stakeholders to develop reporting and interpret HEDIS data.
• Oversees implementation of new initiatives.
• Leads interactions with regulators or oversight entities.
• Oversees quality improvement activities for large state programs.

Skills

Licensure or Certification

Quality Analytics

Education

BS in Health Administration or related field

Job description

• Must Have a Current unrestricted license related to the medical or behavioral health field, or certification in applicable field (i.e. CPHQ).
• This is an Individual Contributor Role.

• Must Have a Current unrestricted license related to the medical or behavioral health field, or certification in applicable field (i.e. CPHQ).
• This is an Individual Contributor Role.

Location: Hybrid 1 - This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office.

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

A proud member of the Elevance Health family of companies, Carelon Behavioral Health uses our powerful combination of experience, expertise, dedication and compassion to see what's possible and what's better. Born out of one of the largest healthcare systems organization in the United States, our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges.

Work Shift: Monday – Friday, 8:30 am to 5:00 pm (EST)

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

• 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.

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

Preferred Skills, Capabilities And Experiences

• MS in the health field (i.e. Nursing) is preferred.
• HEDIS knowledge and experience supporting HEDIS quality improvement initiatives highly preferred.
• Experience interpreting healthcare quality data to identify trends, root causes, and improvement opportunities preferred.

For candidates working in person or virtually in the below location, the salary* range for this specific position is $85,920 to $128,880

Location: Columbus, OH

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 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.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

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.

How We Work

At Elevance Health, 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.

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.

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.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

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. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.