Medicaid Quality Management Health Plan Director

Medicaid Quality Management Health Plan Director

Responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan. Responsible for working with the regional head of quality management to direct the clinical quality initiatives, including HEDIS and CAHPS quality improvement, NCQA accreditation and compliance with regulatory agencies and other objectives.

How You Will Make an Impact :

• 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

Required Qualifications :

Preferred Qualifications :

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

Locations : District of Columbia (Washington, DC)

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.

Job Level : Director Equivalent

Workshift : 1st Shift (United States of America)

Job Family : QLT >

Quality Mgmt

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.