Clinical Quality Program Manager

Role Overview

• Leads state level quality strategy meetings
• Develops a quality plan, and 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 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 research programs 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 line of business
• Oversees the implementation of new initiatives
• Leads interactions with regulators or oversight entities
• Oversees quality improvement activities for the largest, most complex state programs

Requirements

• Requires a BS in health administration, nursing, or a related clinical field
• 4 years of health care quality or data analysis experience
• Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred
• Candidates must reside in Pennsylvania, near West Chester, PA and be within a reasonable commuting distance of an Elevance Health PulsePoint office.

Benefits

• merit increases
• paid holidays
• Paid Time Off
• 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
• financial education resources