Clinical Quality Program Manager

This is an individual contributor role. Location: Virtual – full-time remote work, except for required in-person training sessions. Candidates must reside within a reasonable commuting distance from an office location (e.g., Columbus or Cleveland, Ohio; Virginia) unless accommodation is granted as required by law.

About the Role

A proud member of the Elevance Health family of companies, Carelon Behavioral Health leverages extensive healthcare experience, expertise, and compassion to address pressing healthcare challenges. This role serves as a liaison and oversees quality improvement activities, projects, and programs for one or more states within a major line of business.

Responsibilities

• Participate in quality strategy activities and lead assigned quality improvement initiatives, ensuring integration into overall business processes.
• Lead root cause analyses to identify drivers of HEDIS performance gaps and develop data-informed recommendations and intervention strategies.
• Ensure sound study methodology and appropriate reporting.
• Develop performance improvement plans and oversee clinical quality improvement activities to enhance member care.
• Assure compliance with corporate Quality Improvement (QI) work plans and relevance of QI activities to the targeted population.
• Maintain effective documentation of research programs to meet regulatory and accreditation standards.
• Partner with Analytics and cross-functional stakeholders to develop reporting, interpret HEDIS data, and identify quality improvement opportunities.
• Oversee the implementation of new initiatives and lead interactions with regulators or oversight entities.
• Manage quality improvement activities for the largest, most complex state programs.

Requirements

• Bachelor’s degree in health administration, nursing, or a related clinical field; or equivalent combination of education and experience.
• 4 years of healthcare quality or data analysis experience.
• Current, unrestricted license related to the medical or behavioral health field.
• Certification in an applicable field (e.g., CPHQ).

Preferred Qualifications

• Master’s degree in a health-related field (e.g., Nursing).
• HEDIS knowledge and experience supporting HEDIS quality improvement initiatives.
• Experience interpreting healthcare quality data to identify trends, root causes, and improvement opportunities.

Schedule

Monday – Friday, 8:30 AM to 5:00 PM (EST).

Pay

For candidates working in person or virtually in Columbus, Ohio; Cleveland, Ohio; or Virginia, the salary range for this position is $85,920 to $128,880. The salary offered is based on legitimate, non-discriminatory factors such as geographic location, work experience, education, and skill level.

Benefits

• Comprehensive benefits package (medical, dental, vision, short- and long-term disability, 401(k) with company match, stock purchase plan, life insurance).
• Paid holidays and Paid Time Off (PTO).
• Incentive and recognition programs.
• Wellness programs and financial education resources.

Work Arrangement

Elevance Health operates under a Hybrid Workforce Strategy. Associates are required to work onsite at an Elevance Health location at least once per week, with specific requirements discussed during the hiring process.