Clinical Quality Program Manager-Behavioral Health

Anticipated End Date:

2025-03-20

Position Title:

Clinical Quality Program Manager- Behavioral Health (HEDIS)

Job Description:

Be Part of an Extraordinary Team

Beacon Carelon Behavioral Health A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

Title: Clinical Quality Program Manager

Location: The ideal candidate should live within 50 miles of an open access Elevance Health PulsePoint in a state specified in this requisition. This position will work a hybrid model (remote and office) 1-2x a week onsite.

Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

Build the Possibilities. Make an extraordinary impact.

The Clinical Quality Program Manager is responsible for serving as a liaison with and overseeing the quality improvement activities/projects/programs for one or more states within a major line of business.

How you will make an impact:

Primary duties may include, but are not limited to:

• Leads HEDIS strategy to drive improvement in behavioral health HEDIS measures, ensuring achievement in performance guarantees and/or service level agreements.

• Facilitates cross-functional work groups to drive improvement in member and provider experience.

• Leads cross-functional  quality strategy meetings, develops a quality plan, and ensures integration of quality into the overall business process.

• Leads implementation of improvement strategies using project management tools and resources.

• Conducts root cause analysis  with the clinical intervention team and provider quality managers to design studies to identify barriers to behavioral health activities.

• Ensures that study methodology is sound and appropriate reporting is in place.

• Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of care for members.

• Assures compliance with corporate QI work plans.

• Assures that all QI activities are relevant to the needs of targeted population.

• Maintains effective documentation of programs to meet regulatory and Accreditation Standards.

• Provides oversight to ensure accurate and complete quantitative and qualitative analysis of clinical data and presentation of data analysis results.

• Participates in and provides input to the development of new product designs for major line of business.

• Oversees and project manages the implementation of new initiatives.

• Leads interactions with regulators or oversight entities.

• Oversees quality improvement activities for the largest, most complex plan programs.

Minimum 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, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.

• HEDIS experience is preferred.

• Knowledge of route cause analysis is preferred.

• Project management experience preferred.

For candidates working in person or remotely in the below location(s), the salary* range for this specific position is $79,760.00- 143,568

Locations:  California; Colorado; District of Columbia (Washington, DC), Illinois, Jersey City, NJ; Maryland, Minnesota, Nevada; New York; Washington State

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.  The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

QLT > Clinical Quality

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.