Clinical Quality Program Consultant

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 Consultant plays a crucial role in overseeing quality improvement activities and programs for one or more states within a major line of business at Elevance Health. This position involves co-leading state-level quality strategy meetings, developing quality plans, and ensuring the integration of quality into overall business processes. The consultant will work closely with clinical intervention teams to identify barriers to medical interventions and ensure compliance with corporate Quality Improvement (QI) work plans, ultimately aiming to enhance the quality of care for members.

Responsibilities

• Co-leads state level quality strategy meetings and develops a quality plan.
• 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 clinical quality improvement activities.
• Assures compliance with corporate Quality Improvement (QI) work plans.
• Maintains effective documentation of research programs to meet regulatory and Accreditation Standards.
• Oversees accurate and complete quantitative analysis of clinical data and presentation of results.

Requirements

• Requires a BS in health administration, nursing or a 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

• Medicaid experience highly preferred; Florida Medicaid a plus.
• HEDIS experience highly preferred.
• Quality assurance experience highly preferred.
• Current unrestricted license or certification in applicable field preferred (i.e. CPHQ).
• MS in the health field (i.e. Nursing) preferred.

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