Clinical Quality Program Manager at Elevance Health in Seven Fields, Pennsylvania

Job Description:

Location: Must live within 50 miles of our Seven Fields, PA PulsePoint office.


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:

• 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.


• Assisting with and conducting medical record reviews for Behavioral Health providers


• Train and mentor staff who conduct audits


• 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.


• Oversees the implementation of new initiatives.


• Leads interactions with regulators or oversight entities.


• Oversees quality improvement activities for the largest, most complex state programs.

• 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.

• Strong knowledge of ASAM


• Substance use disorder experience


• Current unrestricted license in behavioral health field (LSW, LCSW, LPC, etc)