Clinical Quality Program Manager at Elevance Health in Nashville, Tennessee

Job Description:

Clinical Quality Program Manager




Location: 22 Century Blvd, STE 310, Nashville, TN 37214


This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days physically in office per week.


Our ideal candidate will live within a reasonable proximity to our Elevance Health major office (PulsePoint) located in Nashville, TN. Elevance Health supports a hybrid workplace model with PulsePoint sites used for collaboration, community, and connection.


The Clinical Quality Program Manager is responsible for overseeing the quality improvement activities/projects/programs and contract requirements for the TennCare Kids population (EPSDT population).



How You Will Make an Impact



Primary duties may include, but are not limited to:

• Leads state level quality strategy meetings for the TennCare Kids population, develops an annual strategy plan, and ensures integration of quality into the overall strategy for the TennCare Kids population.
  
  


• Participate in a collaborative workgroup consisting of other MCOs, the TN Department of Health and TennCare to develop innovative strategies to improve EPSDT screening rates.
  
  


• Ensure annual plan includes goals for enhancing EPSDT screening rates, plans for outreach in counties/regions and/or subpopulations as identified in state meetings among key stakeholders.
  
  


• Oversee all reporting requirements and data analysis to drive strategy.
  
  


• Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of care for members.
  
  


• Assures compliance with all contract requirements and deliverables.
  
  


• Assures that all QI activities for the TennCare Kids population are data driven and activities are targeted and tracked to assess outcomes.
  
  


• Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of data analysis results.
  
  


• Developed and lead implementation strategies based on data analysis to optimize clinical interventions and improve EPSDT and HEDIS rates with a focus on well child and immunizations.
  
  


• Oversees the implementation of new initiatives.
  
  


• Leads interactions with regulators or oversight entities.
  
  


• Work collaboratively with other departments and senior leaders.
  
  

• 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.
  
  


• Managed Care experience.
  
  


• Tennessee specific Medicaid experience.
  
  


• Knowledge of the TennCare Kids Population and EPSDT requirements.
  
  


• Experience with data analysis.
  
  


• Strong Excel skills.
  
  


• Strong verbal and written communication skills.