Clinical Quality Program Manager at Elevance Health in Tampa, Florida
Posted in Other about 18 hours ago.
Job Description:
JR131500 Clinical Quality Program Manager
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.
Location: This position will work a hybrid model (remote and office) and must live within 50 miles of one of our Pulse Point office locations in Florida.
How will you make an impact:
- Leads plan level HEDIS strategy to drive improvement in behavioral health HEDIS measures, ensuring achievement in performance guarantees and/or service level agreements.
- Leads stakeholder advisory committees.
- Leads plan 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 programs to meet regulatory and Accreditation Standards.
- Provides oversight to assure accurate and complete quantitative and qualitative 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 and project manages the implementation of new initiatives.
- Leads interactions with regulators or oversight entities.
- Oversees quality improvement activities for the largest, most complex plan 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.
Preferred Skills, Capabilities, and Experiences:
- Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.
