Job Information
Elevance Health Behavioral Health HEDIS Quality Program Director in SOUTH PORTLAND, Maine
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.
Behavioral Health HEDIS Quality Program Director
This is an Individual Contributor Role.
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:
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.
Minimum Requirements:
- 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.
Preferred Skills, Capabilities and Experiences:
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.