Job Title: Remote Clinical Quality Program Administrator
Location: 100% Remote/Work From Home (Only considering candidates with residing in the state of Lousiana, with an acute clinical license)
*Selected candidate must ensure work at home office is in a dedicated private and secure room adhering to HIPPA compliance regulations.
Business /Working Hours: Monday-Friday | 8:00am-5:00pm Central
How you will make an impact:
Responsible for serving as an expert in data analysis, SQL, data intake/transformation and formulating recommendations and providing guidance to other quality analysts. Analyzes member and measure level HEDIS and HEIDIS-Like data and summarizes performance using available SQL tools and summary statistical procedures. Develops and analyzes business performance analyses and reports (e.g. for claims data, provider data, utilization data) and prepares data for HEDIS and HEDIS-like reporting purposes.
Primary duties may include, but are not limited to:
• Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of care for members.
• Supporting project deliverables to review, test, and provide UAT findings and recommendations on measure testing and implementation for Medicaid HEDIS and HEDIS-like measure sets required for state and internal reporting submissions.
• Supporting production HEDIS and state submission deliverables Medicaid plans.
• Supporting production project deliverables to produce and submit Gaps in Care and other clinical reporting as required.
• Ensures that study methodology is sound and appropriate reporting is in place.
• Creates and publishes periodic reports, as well as any necessary ad hoc reports.
• Ability to clearly communicate and escalate issues to management.
Minimum Requirements :
BS/BA degree in related field; minimum of 3 years’ experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
Government Business Division (GBD) experience, Medicaid preferred.
HEDIS Value sets and specifications experience.
Strong Data Analyis experience is critical and highly desirable in this role.
Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. Previously known as Anthem, Inc., we have evolved into a company focused on whole health and updated our name to better reflect the direction the company is heading.
We are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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.
The health of our associates and communities is a top priority for Elevance Health. We require all new candidates to become vaccinated against COVID-19. If you are not vaccinated, your offer will be rescinded unless you provide – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2021, is ranked as one of the 2021 World’s Most Admired Companies among health insurers by Fortune magazine, and a Top 20 Fortune 500 Companies on Diversity and Inclusion. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 firstname.lastname@example.org for assistance.