Clinical Quality Program Manager

Anticipated End Date:

Position Title:

Job Description:

JR206997 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. This position will primarily support Accreditation readiness activities and serve as a key quality partner in ensuring ongoing compliance with Accreditation standards, with a strong emphasis on NCQA Accreditation requirements, regulatory expectations, and continuous quality improvement.

Location: Hybrid 1: This role requires associates to be in-office 1 day 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.

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 accommodation is granted as required by law.

How will you make an impact:

• Leads state level quality strategy meetings, develops a quality plan, and ensures integration of quality into the overall business process.
• Serves as a subject matter expert and quality lead for Accreditation readiness efforts, including interpretation, implementation, monitoring, and documentation of NCQA Accreditation standards and requirements.
• Partners with business leaders and cross-functional teams to establish, track, and achieve Accreditation-related milestones, deliverables, and readiness activities.
• 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.
• Coordinates and organizes Accreditation work plans, evidence collection, gap assessments, and readiness reviews to support successful Accreditation submissions and surveys.
• 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.
• Collaborates effectively with operational, clinical, compliance, accreditation, and business partners to drive process improvements, strengthen quality outcomes, and support Accreditation performance goals.
• Leads interactions with regulators or oversight entities.
• Oversees quality improvement activities for the largest, most complex state programs.
• Identifies opportunities to improve processes, workflows, documentation practices, and operational controls to enhance organizational readiness and maintain compliance with Accreditation standards.
• Develops and delivers education, guidance, and consultation to stakeholders regarding Accreditation requirements, quality standards, and readiness expectations.

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:

• Strong knowledge of NCQA Accreditation standards, accreditation survey processes, quality management principles, and healthcare regulatory requirements is strongly preferred.
• Candidates should possess exceptional organizational, project management, and communication skills, with demonstrated ability to manage multiple priorities, coordinate across diverse stakeholder groups, and drive complex initiatives to successful completion.
• Experience leading cross-functional teams and facilitating process improvement efforts in support of Accreditation readiness is highly desirable.
• Current unrestricted license, certification in applicable field (i.e., CPHQ) and/or an MS in the health field (i.e., Nursing) is preferred.

Job Level:

Workshift:

Job Family:

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

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.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.