HEDIS Clinical Quality Program Manager
Elevance Health

JR132653 HEDIS Clinical Quality Program Manager

Location: This position requires you to reside within 50 miles (and 1 hour commute) of any open, relevant Elevance Health location AND as part of our Hybrid 1 Work Strategy, you are required to work from your local office location a minimum of 1 day/week.

The HEDIS Clinical Quality Program Manager is responsible for serving as a liaison with and overseeing the HEDIS Roadmap Section 5 quality improvement activities/projects/programs for one or more states within a major line of business. Primary duties may include, but are not limited to:

• Leads HEDIS Section 5 quality strategy meetings, develops a workplan, and ensures management of supplemental data processes.
  
• 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 and HEDIS audit timelines.
  
• Manages workplan, timelines, and coordination with other business areas on data collection, documentation, and audit guidelines.
  
• Maintains effective documentation of process documentation 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 auditors and regulators or oversight entities.
  

• 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, which would provide an equivalent background.
  

• Experience with the HEDIS submission process including the NCQA HEDIS Roadmap and Section 5 Supplemental data process and documentation.
  
• Technical experience in HEDIS data collection guidelines.
  
• Regulatory Compliance: In-depth understanding of regulatory standards and guidelines pertinent to healthcare data and quality reporting
  
• Experience working with Medicaid and Medicare plans a plus.