Description
A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.
How will you make an impact:
- 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 Health Employer Data Information Sets (HEDIS) reporting and the development of action plans to achieve target improvement goals.
- Supports the External Quality Review Organization (EQRO) reporting and state audit processes.
- Provides leadership for QM representation in new business activities.
- Ensures compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies.
- Hires, trains, coaches, counsels, and evaluates performance of direct reports.
*Monday -Friday 9 am - 5:30 pm EST**
**Candidate MUST be a resident of Maryland**
**This position is hybrid. Candidate must be willing to report to the office a minimum of 1 day a week.**
Minimum Requirements:
- Requires a BA/BS in a health or business-related field.
- 10 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
- MSN, MPH, or MPA preferred.
- Minimum of seven (7) years of cross-functional operational experience, three (3) of which using Contractor’s System strongly preferred.
- Minimum of five (5) years’ experience in QA of Medicare/Medicaid coverage and reimbursement regulations and compliance preferred.
- ASAM experience a plus
- Licensed in the area of Behavioral Health STRONGLY preferred.
- CQM experience in a Managed Care Organization preferred.
- Population health management and/or clinical quality program development experience 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. 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.comfor assistance.