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Clinical Quality Program Manager
Elevance Health. Serve as a liaison and oversee quality improvement activities, projects, and programs for one or more states within a major line of business .
About the role
Key responsibilities & impact- Serve as a liaison and oversee quality improvement activities, projects, and programs for one or more states within a major line of business
- Support Accreditation readiness activities and ensure ongoing compliance with Accreditation standards, especially NCQA requirements and regulatory expectations
- Lead state-level quality strategy meetings and develop quality plans integrated into business processes
- Serve as subject matter expert and quality lead for Accreditation readiness, including interpretation, implementation, monitoring, and documentation of NCQA standards
- Partner with business leaders and cross-functional teams to establish, track, and achieve Accreditation milestones, deliverables, and readiness activities
- Work with clinical intervention teams to design studies identifying barriers to medical interventions
- Ensure sound study methodology and appropriate reporting
- Develop performance improvement plans and oversee clinical quality improvement activities to improve member care
- Ensure compliance with corporate QI work plans and relevance of QI activities to targeted populations
- Maintain research-program documentation meeting regulatory and Accreditation standards
- Coordinate Accreditation work plans, evidence collection, gap assessments, readiness reviews, submissions, and surveys
- Oversee accurate quantitative analysis of clinical data and presentation of results
- Participate in development of new product designs for a major line of business
- Oversee implementation of new initiatives
- Collaborate with operational, clinical, compliance, accreditation, and business partners to drive process improvements and quality outcomes
- Lead interactions with regulators or oversight entities
- Oversee quality improvement activities for complex state programs
- Identify opportunities to improve processes, workflows, documentation practices, and operational controls
- Develop and deliver education, guidance, and consultation on Accreditation requirements, quality standards, and readiness expectations
Requirements
What you’ll need- 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 providing an equivalent background
- Strong knowledge of NCQA Accreditation standards, accreditation survey processes, quality management principles, and healthcare regulatory requirements is strongly preferred
- Exceptional organizational, project management, and communication skills
- Ability to manage multiple priorities, coordinate across diverse stakeholder groups, and drive complex initiatives to successful completion
- Experience leading cross-functional teams and facilitating process improvement efforts in support of Accreditation readiness is highly desirable
- Current unrestricted license or certification in an applicable field, such as CPHQ, is preferred
- MS in a health field, such as Nursing, is preferred
- Candidates must be within a reasonable commuting distance from the posting location(s), unless accommodation is granted as required by law
Benefits
Comp & perks- Merit increases
- Paid holidays
- Paid Time Off
- Incentive bonus programs
- Medical benefits
- Dental benefits
- Vision benefits
- Short-term disability benefits
- Long-term disability benefits
- 401(k) with employer match
- Stock purchase plan
- Life insurance
- Wellness programs
- Financial education resources
- Hybrid work arrangement with flexibility for virtual work
- Professional and personal growth opportunities