Clinical Quality Program Manager

About this role

Anticipated End Date: 2026-09-21 Position Title: Clinical Quality Program Manager Job Description: Clinical Quality Program Manager

*This is an Individual Contributor Role.

Location: Virtual - This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office

Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless accommodation is granted as required by law.

A proud member of the Elevance Health family of companies, Carelon Behavioral Health uses our powerful combination of experience, expertise, dedication and compassion to see what's possible and what's better. Born out of one of the largest healthcare systems organization in the United States, our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges.

Work Shift: Monday – Friday, 8:30 am to 5:00 pm (EST)

The Clinical Quality Program Manager 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: • Participates in quality strategy activities and leads assigned quality improvement initiatives, ensuring integration of improvement activities into the overall business process.

• Leads root cause analyses to identify drivers of HEDIS performance gaps and develops data-informed recommendations and intervention strategies.

• Ensures that study methodology is sound and appropriate reporting is in place. 

• Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of care for members. 

• Assures compliance with corporate QI work plans. 

• Assures that all QI activities are relevant to the needs of targeted population. 

• Maintains effective documentation of research programs to meet regulatory and Accreditation Standards. 

• Partners with Analytics and cross-functional stakeholders to develop reporting, interpret HEDIS data, and identify opportunities for quality improvement.

• Oversees the implementation of new initiatives. 

• Leads interactions with regulators or oversight entities. 

• Oversees quality improvement activities for the largest, most complex state programs.

Minimum Requirements: • 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. 

• Current, unrestricted license related to the medical or behavioral health field, certification in applicable field (i.e. CPHQ) . 

Preferred Skills, Capabilities and Experiences: • MS in the health field (i.e. Nursing) is preferred.

• HEDIS knowledge and experience supporting HEDIS quality improvement initiatives highly preferred.

• Experience interpreting healthcare quality data to identify trends, root causes, and improvement opportunities preferred.

For candidates working in person or virtually in the below locations, the salary* range for this specific position is $85,920 to $128,880    Location(s): Columbus, Ohio & Cleveland, OH, Virginia   In addition to your salary, Elevance Health offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company.  The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws.  

*The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education, and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.

Job Level: Non-Management Exempt Workshift: 1st Shift (United States of America) Job Family: QLT > Clinical Quality Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of 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. Our values and behaviors

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