Clinical Quality Program Manager

Location: 22 Century Blvd, STE 310, Nashville, TN 37214

This position will take part in Elevance Health's hybrid workforce strategy which includes virtual work and 1-2 days physically in office per week .

Our ideal candidate will live within a reasonable proximity to our Elevance Health major office (PulsePoint) located in Nashville, TN. Elevance Health supports a hybrid workplace model with PulsePoint sites used for collaboration, community, and connection.

The Clinical Quality Program Manager is responsible for overseeing the quality improvement activities/projects/programs and contract requirements for the TennCare Kids population (EPSDT population).

How You Will Make an Impact

Primary duties may include, but are not limited to:

• Leads state level quality strategy meetings for the TennCare Kids population, develops an annual strategy plan, and ensures integration of quality into the overall strategy for the TennCare Kids population.

• Participate in a collaborative workgroup consisting of other MCOs, the TN Department of Health and TennCare to develop innovative strategies to improve EPSDT screening rates.

• Ensure annual plan includes goals for enhancing EPSDT screening rates, plans for outreach in counties/regions and/or subpopulations as identified in state meetings among key stakeholders.

• Oversee all reporting requirements and data analysis to drive strategy.

• Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of care for members.

• Assures compliance with all contract requirements and deliverables.

• Assures that all QI activities for the TennCare Kids population are data driven and activities are targeted and tracked to assess outcomes.

• Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of data analysis results.

• Developed and lead implementation strategies based on data analysis to optimize clinical interventions and improve EPSDT and HEDIS rates with a focus on well child and immunizations.

• Oversees the implementation of new initiatives.

• Leads interactions with regulators or oversight entities.

• Work collaboratively with other departments and senior leaders.

Minimum Requirements:

• Requires a 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.

Preferred Skills, Capabilities, & Experiences:

• Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.

• Managed Care experience.

• Tennessee specific Medicaid experience.

• Knowledge of the TennCare Kids Population and EPSDT requirements.

• Experience with data analysis.

• Strong Excel skills.

• Strong verbal and written communication skills.

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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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. 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.