Director Quality Management/Improvement

Elevance Health; Boston (MA); Hybrid; USD 135,520 - 212,520; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

401k contribution

Job summary

A leading health company is seeking a Director of Quality Management/Improvement to develop and implement quality programs in Massachusetts. The role requires a minimum of 10 years of healthcare experience, leadership in quality improvement, and relevant licensure. This position fosters a hybrid work model that combines in-office and flexible hours. Competitive salary range is $135,520 to $212,520.

Qualifications

• 10 years of experience in a healthcare environment, including prior management experience.
• Current, active, unrestricted license in MSW, LMHC, APRN, or MFT strongly preferred.
• CQM experience in a managed care organization preferred.

Responsibilities

• Develop and implement a strategic quality management and improvement program.
• Lead audits of delegated services and oversee compliance activities.
• Support continuous quality improvement and promote collaboration across departments.

Skills

Behavioral health quality improvement

Compliance activities

Team leadership

Data analysis

Education

BA/BS in a health or business related field

Job description

Join to apply for the Director Quality Management/Improvement role at Elevance Health.

This role requires associates to be in-office 3 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 can be considered.

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 an accommodation is granted as required by law.

The Director Quality Management/Improvement is responsible for developing, coordinating, communicating, and implementing a strategic quality management and improvement program for a state plan.

**Candidate MUST be domiciled and licensed in the state of Massachusetts**

How will you make an impact

• Develops, deploys and measures behavioral health strategic quality plan for statewide managed care contract and crisis line services.
• Acts as the Quality subject matter expert (SME) supporting continuous quality improvement (CQI) and promotes broad understanding and collaboration across departments, and with external stakeholders.
• Is accountable for development, measurement strategy and implementation of interventions that support Quality Improvement Activities.
• Leads development of performance improvement plans and evaluation program.
• Links strategic efforts with clinical and network to improve experience of care and services of members.
• Oversees quality complaints and grievances and reporting to the state.
• Leads audits of delegated services and oversees compliance activities to ensure regulatory and compliance standards are met.
• Responsible for all KPIs in the contract related to Quality.
• Leads Quality Measure Improvement Plan including HEDIS, Health Equity and other state defined quality measurement intervention program. This includes development of action plans, deployment of interventions and ongoing monitoring of performance. Responsible for overall improvement of incentive program based on measure improvement.
• Supports the External Quality Review Organization (EQRO) reporting and state audit processes.
• Provides leadership for QM representation in new business activities and acts as liaison between company and state partners.
• Ensures compliance with National Committee for Quality Assurance (NCQA) behavioral health and health equity standards for managed care contract and compliance with American Association of Suicidology (AAS) and International Council of Helplines (ICH) accreditations for crisis line services.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.
• BA/BS in a health or business related field; 10 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences

• Extensive experience leading quality performance improvement, implementation, and program development to support accreditation including developing, implementing, monitoring and tracking performance of quality programs strongly preferred.
• Current, active, unrestricted license in MSW, LMHC, APRN, or MFT strongly preferred.
• Advanced knowledge of HEDIS interventions to include clinical intervention strongly preferred.
• Robust capabilities to analyze data insights and strategically implement interventions to address and rectify situations when targets are not being met strongly preferred.
• CQM experience in a managed care organization preferred.
• Population health management and/or clinical quality program development experience preferred.
• 3-5 years of managing direct reports strongly preferred.
• 5 years direct management of quality programs strongly preferred.

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $135,520 to $212,520

Locations: Massachusetts

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, paid time off, stock, 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 may contact [e-mail] for assistance. 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.

Seniority level

Director

Employment type

Full-time

Job function

Health Care Provider

Industries

Hospitals and Health Care