Clinical Quality Program Administrator

Elevance Health - Overland Park, KS

Full-time - Mid Level

Hybrid - Overland Park, KS

11-50 employees

Insurance Carriers and Related Activities

About the position

The Clinical Quality Program Administrator is responsible for overseeing quality improvement activities and projects as outlined in the Quality Improvement (QI) work plan, ensuring compliance with applicable laws, regulations, and accreditation standards. This role integrates quality into business processes, performs assessments to identify gaps, and oversees clinical quality improvement initiatives to enhance care quality for members.

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.
• Assures QI activities are relevant to the targeted population.
• Assures compliance to Practice Guideline, Delegation and Continuity and Coordination of care Standards.
• 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

• Requires a BS in health administration, nursing or related clinical field.
• 3 years of health care quality or data analysis experience, or any combination of education and experience that provides an equivalent background.

Nice-to-haves

• Current unrestricted license or certification in applicable field preferred (i.e. CPHQ).
• Prior HEDIS experience is very strongly preferred.
• Proficient in Microsoft Office applications, especially Excel.
• Strong organizational and data analysis skills.

Benefits

• Merit increases
• Paid holidays
• Paid Time Off
• Incentive bonus programs
• Medical benefits
• Dental benefits
• Vision benefits
• Short and long term disability benefits
• 401(k) with matching
• Stock purchase plan
• Life insurance
• Wellness programs
• Financial education resources