Clinical Quality Program Manager

Elevance Health; Walnut Creek (CA); Hybrid; USD 95,000 - 150,000; Full time

Job summary

A leading health insurance provider is seeking a Clinical Quality Program Manager in California. This role involves leading quality strategy meetings, developing performance improvement plans, and ensuring compliance with quality initiatives. Candidates should have a BS in health administration, nursing, or a related field along with experience in health care quality or data analysis. Salary range is $95,680 to $149,760 and hybrid work is available.

Qualifications

• 4 years of health care quality or data analysis experience, or equivalent education and experience.

Responsibilities

• Leads state change to health plan level quality strategy meetings.
• Works with clinical teams to design studies identifying barriers to interventions.
• Oversees clinical quality improvement activities/projects.

Skills

Health care quality

Data analysis

Intermediate Excel skills

Intermediate PowerPoint skills

Education

BS in health administration, nursing, or a related field

Job description

Anticipated End Date: 2025-11-13

Position Title: Clinical Quality Program Manager

Shift: Monday – Friday; 8:00am – 5:00pm PT

Location: Walnut Creek, CA (Candidates must be within the state of California)

Hybrid Work: Requires in-office 1 day per week; additional remote work allowed.

Responsibilities

• Leads state change to health plan 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 the 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

• 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 that would provide an equivalent background.

Preferred Skills & Capabilities

• Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or an MS in the health field (i.e. Nursing) is preferred.
• Intermediate Excel and PowerPoint skills.
• Prior experience with HEDIS and NCQA Health Plan Accreditations.

Compensation

Salary Range: $95,680.00 to $149,760.00

Location

California

Equal Employment Opportunity Statement

Elevance Health is an Equal Employment Opportunity employer. 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 may contact [e-mail] for assistance.