Director Quality Management / Improvement

Director Quality Management / Improvement

This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations can be considered. Please note that per our policy on hybrid / virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

The Director Quality Management / Improvement is responsible for developing, coordinating, communicating, and implementing a strategic quality management and improvement program for a state plan. Candidate MUST be domiciled and licensed in the state of Massachusetts.

How Will You Make An Impact :

• Develops, deploys and measures behavioral health strategic quality plan for statewide managed care contract and crisis line services.
• Acts as the Quality subject matter expert (SME) supporting continuous quality improvement (CQI) and promotes broad understanding and collaboration across departments, and with external stakeholders.
• Is accountable for development, measurement strategy and implementation of interventions that support quality improvement activities.
• Leads development of performance improvement plans and evaluation program.
• Links strategic efforts with clinical and network to improve experience of care and services of members.
• Oversees quality complaints and grievances and reporting to the state.
• Leads audits of delegated services and oversees compliance activities to ensure regulatory and compliance standards are met.
• Responsible for all KPIs in the contract related to Quality.
• Leads Quality Measure Improvement Plan including HEDIS, Health Equity and other state defined quality measurement intervention program. This includes development of action plans, deployment of interventions and ongoing monitoring of performance.
• Supports the External Quality Review Organization (EQRO) reporting and state audit processes.
• Provides leadership for QM representation in new business activities and acts as liaison between company and state partners.
• Ensures compliance with National Committee for Quality Assurance (NCQA) behavioral health and health equity standards for managed care contract and compliance with American Association of Suicidology (AAS) and International Council of Helplines (ICH) accreditations for crisis line services.
• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements :

Preferred Skills, Capabilities and Experiences :

For candidates working in person or virtually in the below location(s), the salary

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. 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 elevancehealthjobssupport@elevancehealth.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.