Position Title:

Clinical Quality Program Manager

Job Description:

Location: MA-Boston

Job Description Summary:
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:

• Participate in 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.

• Use HEDIS data to identify opportunities for improvement

• 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:

• 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, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.

Preferred Qualifications:

• Experience with NCQA accreditation and HEDIS analysis

• Project management experience

Job Level:

Non-Management Exempt

Workshift:

Job Family:

QLT > Clinical Quality

Be part of an Extraordinary Team

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?

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, providing various levels of flexibility while also ensuring that associates have opportunities to connect in-person. Unless in a designated virtual-eligible role and 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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.