Location: This is a work from home position with a preferred location of Miami, FL. However, will consider any qualified candidate that resides in the state of Florida.
Responsible for serving as a liaison with and overseeing the quality improvement activities and programs for one or more states within a major line of business.
Primary duties may include, but are not limited to:
- Co-leads state level quality strategy meetings, develops a quality plan, and ensures integration of quality into the overall business process.
- Works with the clinical intervention team to design studies to identify barriers to medical interventions.
- Ensures that study methodology is sound and appropriate reporting is in place.
- Develops performance improvement plans and oversees the clinical quality improvement activities to improve the quality of care for members.
- Assures compliance with corporate Quality Improvement (QI) work plans.
- Assures QI activities are relevant to targeted population.
- Maintains effective documentation of research programs to meet regulatory and Accreditation Standards.
- Oversees accurate and complete quantitative analysis of clinical data and presentation of results.
- Develop, implement, and revise as necessary, the Risk Management Program, and its policies and procedures.
- Track and trend all occurrences/incidents to identify risk and quality of care issues
- Develop appropriate measures to minimize the risk of injury to Plan enrollees and/or associates.
- Develop and maintain educational programs for employees, practitioners, and plan enrollees to minimize injuries and incidents.
- Provide appropriate training and take corrective action as needed to ensure plan associates, participating providers and direct service providers comply with critical incident reporting requirements.
- Analyze incidents in relation to patient access to care and quality care/medical services.
- Assure the development of regular and systematic review of all incident reports for the purpose of identifying trends and patters as to time, place or persons.
- Develop, implement, and maintain Board of Directors reporting on a quarterly basis.
Required Qualifications: BS in health administration, nursing or a related clinical field; 3 years of health care quality or data analysis experience; or any combination of education and experience, which would provide an equivalent background.
Preferred qualifications, skills and experience: Current unrestricted license or certification in applicable field preferred (i.e. CPHQ). MS in the health field (i.e. Nursing) preferred. Licensed Risk Manager strongly 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. A Fortune 20 company with a longstanding history in the healthcare industry, 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 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 – 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 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. 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 email@example.com for assistance.