Title : Clinical Quality Program Manager (Risk Adjustment)
Location: TX (preferred)| CA| WA |TX| NM |AZ| Candidate required to reside in posted state
Build the Possibilities. Make an extraordinary impact.
Clinical Quality Program Manager (Risk Adjustment) is responsible for serving as a liaison with and overseeing the quality improvement activities/projects/programs for one or more states within a major line of business.
How you will make an impact:
• Leads state level risk adjustment strategy meetings, develops a quality plan, and ensures integration of quality into the overall business process.
• Works with the risk adjustment team to design studies to identify barriers to interventions.
• Ensures that study methodology is sound and appropriate reporting is in place.
• Develops performance improvement plans and oversees the risk adjustment improvement activities/projects to improve the quality of care for members.
• Assures compliance with corporate risk adjustment work plans.
• Assures that all risk adjustment activities are relevant to the needs of targeted population.
• Provides oversight to assure accurate and complete quantitative analysis of 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 regulators or oversight entities.
• Oversees quality improvement activities for the largest, most complex state programs.
• 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 and Experiences:
• 3-5 years of risk adjustment strongly preferred.
• Project management experience preferred.
• Experience in Microsoft office preferred.
• Quality Improvement work plan 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 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.