Medicaid Quality Management Health Plan Director

• Works with both internal and external customers to promote understanding of quality management activities and objectives within the company and to prioritize departmental projects according to corporate, regional, and departmental goals.
  
• Maintains expert knowledge of current industry standards, quality improvement activities, and strong medical management skills.
  
• Serves as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements.
  
• Collaborates with other leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans, year round medical record review, and over read processes.
  
• Monitors and reports quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements.
  

• Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and a minimum 5 years experience in a health care environment or any combination of education and experience, which would provide an equivalent background.
  

• Strong BH quality management experience to include oversight of state-specific Quality Improvement Projects (QIPs), STARS, and HEDIS performance metrics strongly preferred.
  
• Certified Professional in Healthcare Quality (CPHQ) from the National Association for Healthcare Quality, or Healthcare Quality and Management (HCQM) certification from the American Board of Quality Assurance and Utilization Review Physicians strongly preferred.
  
• Demonstrated expertise with NCQA accreditation (including behavioral health and health equity standards), survey readiness, and ongoing compliance activities strongly preferred.
  
• Extensive experience leading large-scale, cross-functional initiatives involving data integration, reporting infrastructure, and partnership with IT and analytics teams (e.g., HIE or similar data exchange efforts) strongly preferred.
  
• Proven ability to lead in a highly matrixed environments as well as partnering with clinical, network, analytics, and external stakeholders while facilitating governance forums and driving accountability across teams strongly preferred.
  
• Experience managing state-regulated contracts with high reporting volume strongly preferred.
  
• Deep familiarity with clinical workflows, member safety events, and behavioral health care delivery models strongly preferred.
  

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.

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 View email address on aplitrak.com 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