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Medicaid QM Health Plan Dir (US)

  • Job Family: Customer Care
  • Type: Full time
  • Date Posted:
  • Req #: JR2763


  • NY, Latham
  • New Jersey, Newark
  • Connecticut, Bridgeport
  • Connecticut, Connecticut
  • New York, New York City
  • New York, New York



Build the Possibilities.  Make an extraordinary impact. Beacon 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. Beacon Health Options is a proud member of the Elevance Health family of companies.

The desired candidate must live in the tri state area (NY, NJ, or CT).

The Medicaid QM Health Plan Director position is responsible for the Medicaid Health Plan Business in New York.  This includes Independent Health Plan (IHA), Hamaspik, ICircle, Amida Care, Visiting Nurses Association, and Emblem Medicaid.  In addition, there are 4 of 9 NY State MAP plans that go live on 1/1/23 that the Medicaid Director will assume responsibility for implementing in Q3-Q4 2022.  There are $380,000 in HEDIS Performance Guarantee's at risk for the NY accounts currently. Responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plans. 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 Elevance Health 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, NYS Performance 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. 
  • Position will also support the Empire Plan account
  • Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences) and a minimum 5 years progressively responsible experience in a health care environment or any combination of education and experience, which would provide an equivalent background.

Preferred qualifications

  • MS or advanced degree in a health care related field (i.e. nursing, health education) or business strongly preferred
  • Previous experience working with NCQA, and Behavioral Health HEDIS preferred.
  • Medicaid health plan experience preferred
  • Behavioral Health experience preferred
  • Strong analytical skills preferred
  • QI process experience preferred

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 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 for assistance.

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