Program Manager-LTSS

Elevance Health • Des Moines, VA

11h • Hybrid

About The Position

Program Manager Hybrid 1: This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Program Manager is responsible for the development and ongoing management of one or more multi-year external client facing programs within a business unit. Program managers typically support business strategies through an integrated portfolio of external client facing projects or initiatives. A program manager may have responsibility for a piece of a larger enterprise/regional external client facing program. How you will make an impact: Primary duties may include, but are not limited to: Provide program management supporting LTSS HEDIS and quality activities across Medicaid LTSS markets. Support end-to-end LTSS HEDIS operations, including data collection, validation, reporting, and audit readiness in alignment with contractual and regulatory requirements. Support LTSS markets in maintaining compliance with NCQA LTSS Distinction standards and evolving CMS HCBS Quality Measure Set requirements under the Medicaid Access Final Rule. Support LTSS HEDIS data logic, mapping, and measuring specifications, accounting for state-specific assessment tools, systems, and contractual nuances. Partner with internal stakeholders and market teams to ensure accurate, timely, and compliant LTSS quality reporting aligning audit and performance teams across all participating states. Support annual LTSS HEDIS audits, including review and oversight of member record reviews, IRR reviews, and overreads. Support implementation and integration of new LTSS quality measures, assessing operational impact, data availability, validation requirements, and audit implications. Identify risks related to compliance, data integrity, audit readiness, and operational capacity, and proactively develop mitigation strategies. Drive process improvement, documentation, and standardization to improve consistency, efficiency, and quality outcomes across markets. Provide backup coverage and business continuity for the LTSS COE Quality Program Director. Develop and deliver training, guidance, and technical support to markets and internal teams on LTSS Quality requirements and best practices. Monitor regulatory changes and emerging requirements to ensure the LTSS COE remains proactively compliant and audit-ready. Support continuous quality improvement initiatives to strengthen quality performance, member surveys, state evaluations, and contract compliance.

Requirements

• Requires a BA/BS
• minimum of 5 years external client facing experience in program/project management; or any combination of education and experience, which would provide an equivalent background.

Nice To Haves

• 5-7 years of LTSS experience.
• Experience conducting case management audits.
• Experience analyzing data and quality data reviews.
• Experience developing and implementing quality projects (such as PIPs or Quality Assessment and Process Improvement – QAPI).
• Experience supporting LTSS Quality programs such as LTSS HEDIS, LTSS Distinction and CMS LTSS Quality Measures preferred.
• Medicaid HEDIS and Medicare Stars knowledge/experience.
• Six Sigma Certification.

Responsibilities

• Provide program management supporting LTSS HEDIS and quality activities across Medicaid LTSS markets.
• Support end-to-end LTSS HEDIS operations, including data collection, validation, reporting, and audit readiness in alignment with contractual and regulatory requirements.
• Support LTSS markets in maintaining compliance with NCQA LTSS Distinction standards and evolving CMS HCBS Quality Measure Set requirements under the Medicaid Access Final Rule.
• Support LTSS HEDIS data logic, mapping, and measuring specifications, accounting for state-specific assessment tools, systems, and contractual nuances.
• Partner with internal stakeholders and market teams to ensure accurate, timely, and compliant LTSS quality reporting aligning audit and performance teams across all participating states.
• Support annual LTSS HEDIS audits, including review and oversight of member record reviews, IRR reviews, and overreads.
• Support implementation and integration of new LTSS quality measures, assessing operational impact, data availability, validation requirements, and audit implications.
• Identify risks related to compliance, data integrity, audit readiness, and operational capacity, and proactively develop mitigation strategies.
• Drive process improvement, documentation, and standardization to improve consistency, efficiency, and quality outcomes across markets.
• Provide backup coverage and business continuity for the LTSS COE Quality Program Director.
• Develop and deliver training, guidance, and technical support to markets and internal teams on LTSS Quality requirements and best practices.
• Monitor regulatory changes and emerging requirements to ensure the LTSS COE remains proactively compliant and audit-ready.
• Support continuous quality improvement initiatives to strengthen quality performance, member surveys, state evaluations, and contract compliance.

Benefits

• We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level