Clinical Quality Program Administrator

Elevance Health - Miami, FL

Full-time - Mid Level

Miami, FL

11-50 employees

Insurance Carriers and Related Activities

About the position

The Clinical Quality Program Administrator at Elevance Health is responsible for overseeing quality improvement activities and projects as outlined in the Quality Improvement (QI) work plan. This role ensures compliance with applicable laws, regulations, and accreditation standards while integrating quality into the overall business process. The administrator will perform assessments to identify gaps in quality and technology assessment processes, oversee clinical quality improvement activities, and maintain documentation to meet regulatory standards.

Responsibilities

• Ensures integration of quality into the overall business process.
• Performs assessments to identify gaps in the enterprise's quality and technology assessment processes and initiates actions to correct these gaps.
• Assures accuracy and completeness of input provided to internal and external QI committees and timely implementation of appropriate interventions.
• Oversees the clinical quality improvement activities/projects to implement appropriate clinical interventions to improve the quality of care for members.
• Assures compliance with corporate QI work plans and that QI activities are relevant to the targeted population.
• Maintains 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 results.
• May provide oversight to the Healthcare Effectiveness Data and Information Set (HEDIS) project team.

Requirements

• Bachelor's degree in health administration, nursing, or related clinical field.
• 3 years of health care quality or data analysis experience.
• Current unrestricted license or certification in applicable field preferred (i.e. CPHQ).
• Master's degree in the health field (i.e. Nursing) preferred.

Nice-to-haves

• Florida Medicaid plan experience highly preferred.
• Managed Care Organization (MCO) experience preferred.

Benefits

• Employee stock purchase plan
• Paid holidays
• Disability insurance
• Health insurance
• Dental insurance
• Paid time off
• Vision insurance
• 401(k) matching
• Life insurance