The Clinical Quality Program Manager is responsible for serving as a liaison with and overseeing the Clinical quality improvement activities/projects/programs for delegated states/clients.

Location: This position will work a hybrid model (1-2 days in the office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

How you will make an impact:

• Responsible for delegation oversight and integration of activities with the Client and key stakeholders.

• Provides oversight and support to key stakeholders to ensure delegation activities are completed timely and accurately, and in compliance with NCQA standards

• Leads client specific clinical quality strategy meetings, supports the development of clinical 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 including HEDIS to improve the quality of care for members.

• Assures compliance with corporate QI and Clinical work plans.

• Assures that all QI/Clinical activities are relevant to the needs of targeted population.

• Maintains effective documentation of programs, policies 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 lines of business.

• Oversees the implementation of new initiatives.

• Participates in meetings with regulators or oversight entities when required.

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:

• NCQA accreditation, HEDIS interventions, Managed BH care experience, Current unrestricted license or a MS in the health field (i.e. Nursing) is preferred.