Clinical Quality Program Manager

Elevance Health - Indianapolis, IN

Full-time - Mid Level

Indianapolis, IN

5,001-10,000 employees

Insurance Carriers and Related Activities

About the position

The Clinical Quality Program Manager leads the behavioral health HEDIS health intervention program for individuals with serious mental illness across multiple markets. This role involves developing work plans, monitoring metrics, and supporting the deployment of new interventions while ensuring quality integration into business processes. The position operates in a hybrid model, requiring weekly in-office attendance at an Elevance Health location.

Responsibilities

• Lead the behavioral health HEDIS health intervention program for the CCPSMI population.
• Develop HEDIS work plans and metrics monitoring.
• Support new HEDIS intervention deployment.
• Conduct root cause analysis for measures not meeting targets.
• Ensure fidelity of standardized HEDIS interventions through auditing.
• Facilitate stakeholder workgroups to review data and share best practices.
• Collaborate with reporting/analytics teams on leading indicators for program effectiveness.
• Develop performance improvement plans and oversee clinical quality improvement activities.
• Maintain effective documentation of quality programs to meet regulatory standards.
• Provide oversight for accurate quantitative analysis of clinical data.

Requirements

• Bachelor's degree in health administration, nursing, or a related clinical field.
• 4 years of healthcare quality or data analysis experience.

Nice-to-haves

• Background in process/performance improvement, lean six sigma.
• Experience in behavioral health care with Serious Mental Illness (SMI) population.
• Expertise in cross-functional leadership.
• Experience in managed care and BH HEDIS measure improvement.

Benefits

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