HEDIS Clinical Quality Program Manager

Elevance Health - Atlanta, GA

Full-time - Mid Level

Atlanta, GA

5,001-10,000 employees

Insurance Carriers and Related Activities

About the position

The HEDIS Clinical Quality Program Manager is responsible for overseeing quality improvement activities related to HEDIS Roadmap Section 5 for multiple states within a major line of business. This role involves leading strategy meetings, developing work plans, ensuring compliance with quality improvement work plans, and managing data collection and audit processes to enhance the quality of care for members.

Responsibilities

• Lead HEDIS Section 5 quality strategy meetings and develop work plans.
• Ensure management of supplemental data processes and compliance with corporate QI work plans.
• Develop performance improvement plans and oversee clinical quality improvement activities.
• Maintain effective documentation to meet regulatory and accreditation standards.
• Provide oversight for accurate quantitative analysis of clinical data and present analysis results.
• Participate in the development of new product designs for major lines of business.
• Oversee the implementation of new initiatives and lead interactions with auditors and regulators.

Requirements

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

Nice-to-haves

• Experience with the HEDIS submission process and NCQA HEDIS Roadmap.
• Technical experience in HEDIS data collection guidelines.
• In-depth understanding of regulatory standards and guidelines for healthcare data and quality reporting.
• Experience working with Medicaid and Medicare plans.

Benefits

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