- This is an Individual Contributor Role.
- Develops and facilitates the integration of a national quality plan.
- Develops performance improvement plans and oversees the clinical quality improvement activities/projects.
- Participates in the development, management, review and reporting of program outcomes for clinical quality programs.
- Assures compliance with corporate Quality Improvement work plans.
- Assures accurate and complete quantitative analysis of clinical data.
- Leads department projects and mentors staff.
- Prepares and presents program documents to senior management.
- Accountable for leading enterprise-wide cross-functional behavioral health HEDIS and other Quality projects across the lifespan, from inception through communication of actionable findings, and provides collaborative guidance and consultation to internal and external partners.
- Develops detailed project plans, all program documents, workflows and training materials, outcomes reporting, QIAs in compliance with regulatory and accreditation standards
- Organizational SME for HEDIS programs, intervention deployment, and continuous quality improvement.
- Implements effective communication plans and change management strategies to facilitate organizational adoption of quality initiatives.
- Guides strategic efforts with clinical and network to improve experience of care and services of members.
- Requires a BS in health administration, nursing or a related clinical field; must have a minimum of 5 years of health care quality or data analysis experience ; or an equivalent combination of education and experience, which would provide an equivalent background.
- Current, unrestricted license or certification in an applicable field (i.e. CPHQ) or MS in the health field (i.e. Nursing) preferred.
- Understanding of MBHO/health plan operations across functional areas strongly preferred.
- Experience with behavioral health HEDIS and specifically developing and implementing targeted clinical, network, and vendor programs to drive measurable improvements in outcomes and rates highly preferred.
- Experience developing clinical workflows ensuring outcome reporting during process builds through data warehouse mapping/extraction.
- Strategic leader with tactical expertise ability to execute with excellence independently.
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Behavioral Health HEDIS Quality Program Director - Boston, United States - Elevance Health
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.
Location:
This position will work a Hybrid Model (remote and office). Ideal candidates Must live within 50 miles or a 1 hour commute to an Elevance Health corporate office.
Work Shift Hours:
Monday through Friday, 40 hrs a week.
The Behavioral Health HEDIS Quality Program Director is responsible for leading and implementing enterprise-wide Quality initiatives to improve HEDIS and execute quality strategic priorities across the organization.
How you will make an impact:
Minimum Requirements:
Preferred Skills, Capabilities and Experiences:
Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with 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.
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.
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.
