Job Information
Elevance Health Director Quality Management/Improvement-Behavioral Health Background STRONGLY preferred in HANOVER, Maryland
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.
Responsible for developing, coordinating, communicating, and implementing a strategic quality management and improvement program for a state plan.
How will you make an impact:
Acts as the Quality subject matter expert (SME) supporting continuous quality improvement (CQI) and promotes broad understanding and collaboration across departments, and with external stakeholders.
Is accountable for development, measurement strategy and implementation of interventions that support Quality Improvement Activities.
Leads development of performance improvement plans and evaluation program.
Links strategic efforts with clinical and network to improve experience of care and services of members.
Oversees quality complaints and grievances and reporting to the state.
Leads audits of delegated services and oversees compliance activities to ensure regulatory and compliance standards are met.
Responsible for all KPIs in the contract related to Quality.
Leads Health Employer Data Information Sets (HEDIS) reporting and the development of action plans to achieve target improvement goals.
Supports the External Quality Review Organization (EQRO) reporting and state audit processes.
Provides leadership for QM representation in new business activities.
Ensures compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies.
Hires, trains, coaches, counsels, and evaluates performance of direct reports.
Monday -Friday 9 am - 5:30 pm EST*
*Candidate MUST be a resident of Maryland*
*This position is hybrid. Candidate must be willing to report to the office a minimum of 1 day a week.*
Minimum Requirements:
Requires a BA/BS in a health or business-related field.
10 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background.
Preferred Skills, Capabilities and Experiences:
MSN, MPH, or MPA preferred.
Minimum of seven (7) years of cross-functional operational experience, three (3) of which using Contractor’s System strongly preferred.
Minimum of five (5) years’ experience in QA of Medicare/Medicaid coverage and reimbursement regulations and compliance preferred.
ASAM experience a plus
Licensed in the area of Behavioral Health STRONGLY preferred.
CQM experience in a Managed Care Organization preferred.
Population health management and/or clinical quality program development experience preferred.
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