Clinical Quality Program Manager at Elevance Health

Walnut Creek, California, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years), Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

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 providing equivalent background)
Candidates must be within the state of California
Within reasonable commuting distance from Walnut Creek, CA (unless accommodation granted)

Responsibilities

Serves as a liaison with and oversees quality improvement activities/projects/programs for one or more states within a major line of business
Leads state change to health plan 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 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

Skills

Quality Improvement

Program Management

Clinical Interventions

Performance Improvement Plans

Data Analysis

Regulatory Compliance

Accreditation Standards

Healthcare Quality

Strategic Planning

Project Oversight

Quantitative Analysis

Study Design

Medical Interventions

Elevance Health

Integrated health services and digital platform

About Elevance Health

Elevance Health focuses on enhancing the health of individuals throughout their lives by evolving from a traditional health benefits organization into a comprehensive health partner. The company serves over 118 million people, providing support at every stage of health through an integrated approach that addresses a wide range of health needs. Their services are backed by advanced capabilities and a digital health platform that streamlines access to care. Unlike many competitors, Elevance Health emphasizes a holistic view of health, aiming to redefine health and improve community well-being. The ultimate goal is to make health improvements accessible to everyone.

Indianapolis, IndianaHeadquarters

1944Year Founded

$309.4MTotal Funding

IPOCompany Stage

Enterprise Software, Social Impact, HealthcareIndustries

10,001+Employees

Benefits

Medical, dental, & vision insurance

401(k) + match

Paid holidays

Paid Time Off

Incentive bonus programs

Stock purchase plan

Life insurance

Wellness Programs

Financial education resources

Adoption & Surrogacy Assistance

Dependent-care Flexible Spending Account (DCFSA)

Parental Leave

Parental Transition Week

Critical Caregiving Leave

Risks

Departure of CFO John Gallina may create a gap in financial leadership.

Lawsuit against CMS over MA Star Ratings could lead to financial penalties.

CareBridge integration may face operational challenges, disrupting service delivery.

Differentiation

Elevance Health integrates whole health approach with digital health platform for comprehensive care.

Acquisition of CareBridge enhances home health services within Carelon division.

Strategic partnership with Clayton, Dubilier & Rice aims to innovate primary care delivery.

Upsides

AI integration in home health services can reduce hospital readmissions and improve outcomes.

Predictive analytics support early disease detection, aligning with Elevance's whole health approach.

Telehealth expansion offers opportunities to reach more patients remotely.

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