Director Of National Quality Management

Description

Director National Quality Management

Location: This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

The Director National Quality Management is responsible for collaborating with business partners in a matrixed organization and driving the development, coordination, communication, and implementation of a strategic population health management agenda, metrics, and outcome models for evaluation of projects and programs that meet client expectations. Oversees the Wellpoint Health Equity accreditation initiative and designs and implements strategies to reduce health disparities.  Leads interdisciplinary workgroups and meetings to align medical and BH staff, standardize measurement of process measures and health outcomes, and promote greater collaboration and integration across clinical teams.

How you will make an impact:

• Develops, implements, and leads an industry leading quality improvement program for the Wellpoint product in Massachusetts ensuring that all performance guarantee metrics and client requirements are met and/or exceeded.
• Designs, analyzes, and utilizes claims and authorization data to quantify and improve the quality of care and utilization management activities. Produces and oversees production of a dashboard comprising care management, UM, and other metrics, and reports required for meeting contractual and accreditation standards.
• Provides Quality thought leadership to Sales teams/RFPs and creates quality-related articles for members and providers.
• Ensures ongoing compliance with accreditation (NCQA and URAC) standards. Leads and/or chairs quality committees.
• Serves as the lead for the Cultural and Linguistics program within assigned territory.
• Leads quality performance improvement, implementation, and program development to support accreditation including developing, implementing, monitoring and tracking performance of regional quality programs.
• Participates with Corporate Quality and other regional Quality leads on various quality committees, as assigned by the Chief Medical Officer. Monitors Service Level Agreements (SLA) relating to quality and implements and monitors Corrective Action Plans (CAPs) in collaboration with internal stakeholders, clients, and providers. Implements and monitors CAPs related to Corporate Quality as well as external client delegation and regulatory audits for accreditation readiness.
•  Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Minimum Requirements:

• Requires a BA/BS in a clinical or health related field; 10 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which will provide an equivalent background.
• Ability to travel may be required

Preferred Skills, Capabilities, and Experiences:

• MS or advanced degree in a health care related field preferred
• Familiarity with patient-centered medical home, alternative payment models, and innovative care delivery systems is highly desirable. 
• Knowledge of planning models and methodology, project management and change management experience (strategic and execution) strongly preferred.
• Six Sigma, PMP or CPHQ background or equivalent experience is desirable.
• Executive level communication and presentation experience is preferred.
• Residency in Massachusetts highly preferred 
• Nursing degree or a BA/BS in another clinical or health related field
• Knowledge of HEDIS measures and experience with HEDIS improvement strategies and gaps in care closure
• Facility with interpreting data and creation of dashboards
• Experience with cross functional communication.

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 are the root of our culture. 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.

Elevance Health operates in a Hybrid Workforce Strategy. 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. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.comfor assistance.