Clinical Quality Program Manager

Elevance Health•Walnut Creek, CA

1d•Hybrid

About The Position

The Clinical Quality Program Manager is 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. 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. 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.

Requirements

Requires a BS in health administration, nursing, or a related clinical field
4 years of health care quality or data analysis experience
any combination of education and experience, which would provide an equivalent background.

Nice To Haves

Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.
Experience with NCQA and HEDIS strongly preferred
Knowledge of DMHC and/or DHCS health plan regulations strongly preferred

Responsibilities

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.
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.
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.