Clinical Quality Program Manager

Elevance Health - Indianapolis, IN

Full-time - Mid Level

Indianapolis, IN

11-50 employees

Insurance Carriers and Related Activities

About the position

The Clinical Quality Program Manager leads the behavioral health HEDIS health intervention program for the comprehensive care of individuals with serious mental illness across multiple markets. This role involves developing work plans, monitoring metrics, and supporting the deployment of new HEDIS interventions while ensuring quality integration into business processes and strategic programming across stakeholder groups.

Responsibilities

• Develops HEDIS related trainings for clinical and network staff intervention deployment.
• Conducts root cause analysis for all measures not meeting target and intervention programs to address deficiencies.
• Ensures fidelity of standardized HEDIS interventions through auditing of clinical records.
• Facilitates stakeholder workgroups to review data, share best practices, and improve the BH HEDIS intervention program.
• Collaborates with reporting/analytics teams on the development of leading indicators to demonstrate program effectiveness.
• Ensures that study methodology is sound and appropriate reporting is in place.
• Develops performance improvement plans and oversees clinical quality improvement activities/projects to improve the quality of care for members.
• Assures that all QI activities are relevant to the needs of the targeted population.
• Maintains effective documentation of the quality program to meet regulatory and Accreditation Standards.
• 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 lines of business.
• Oversees the implementation of new quality initiatives to support the CCPSMI BH program.

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 that provides an equivalent background.

Nice-to-haves

• Background in process/performance improvement, lean six sigma.
• Experience in the behavioral health care field with Serious Mental Illness (SMI) population.
• Expertise in cross-functional leadership.
• Develop new clinical and network interventions to improve BH HEDIS measure performance.
• Experience in managed care and with BH HEDIS measure improvement at the member, provider, and systems level.
• Population health, health equity, and stratification of data to improve delivery of care.
• Identification of outcomes measures is necessary.

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