Clinical Quality Program Manager

Jobtailor; West Chester (Chester County); On-site; USD 85,000 - 115,000; Full time

Job summary

Elevance Health PulsePoint seeks a driven quality professional to shape state-level quality strategy, develop plans, and integrate quality into the business process.

You will collaborate with clinical intervention teams to design studies, ensure sound methodologies, and drive continuous improvement across major programs.

Applicants should have a BS in health administration or related field, 4 years of healthcare quality experience, and Pennsylvania residency near West Chester.

Qualifications

• Requires a BS in health administration, nursing, or a related clinical field.
• 4 years of health care quality or data analysis experience.
• Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.
• Candidates must reside in Pennsylvania, near West Chester, PA and be within a reasonable commuting distance of an Elevance Health PulsePoint office.

Responsibilities

• 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

Skills

Leadership

Communication

Regulatory knowledge

Data analysis

Education

BS in health administration

MS in health field (nursing)

CPHQ certification

Job description

Responsibilities

• 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

Requirements

• Requires a BS in health administration, nursing, or a related clinical field
• 4 years of health care quality or data analysis experience
• Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred
• Candidates must reside in Pennsylvania, near West Chester, PA and be within a reasonable commuting distance of an Elevance Health PulsePoint office.