Clinical Quality Program Director – Next Generation MyCare Ohio

Primary duties may include, but are not limited to:

• Leads quality strategy meetings and serves as a subject matter expert for the MyCare Ohio program, partnering with health plan leadership, enterprise quality teams, and state stakeholders to advance program goals.
• Develops and facilitates the integration of quality improvement strategies, workplans, and initiatives that support MyCare Ohio quality measures and contractual requirements.
• Identifies and integrates best practices, quality interventions, and performance improvement opportunities that drive measurable improvements in quality outcomes and member care.
• Develops performance improvement plans and oversees quality improvement activities, including monitoring HEDIS and other quality measures, analyzing trends, and implementing corrective strategies.
• Participates in the development, management, review, and reporting of program outcomes, quality initiatives, regulatory requirements, and performance metrics.
• Assures compliance with corporate Quality Improvement workplans, state contract requirements, regulatory standards, and program governance requirements.
• Oversees annual quality program documentation, including program descriptions, workplans, evaluations, and other required regulatory submissions.
• Assures accurate and complete quantitative and qualitative analysis of clinical and quality performance data, including root cause analysis and identification of improvement opportunities.
• Leads department projects, facilitates quality governance committees, and collaborates across provider, population health, utilization management, and enterprise quality functions.
• Prepares and presents quality program updates, performance results, and strategic recommendations to senior leadership and external stakeholders.

Requires a BS in health administration, nursing or a related clinical field; 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 RN license, applicable clinical licensure, Certified Professional in Healthcare Quality (CPHQ), or Master's degree in Nursing, Healthcare Administration, Public Health, or a related healthcare discipline preferred.
• Experience leading quality management, quality improvement, HEDIS, STARs, or healthcare performance measurement initiatives within a managed care, Medicaid, Medicare, or health plan environment preferred.
• Strong knowledge of Medicaid, Medicare, Dual Eligible, Next Generation MyCare Ohio, or other integrated care program populations preferred.
• Experience interpreting state contracts, regulatory requirements, accreditation standards, and compliance expectations within a regulated healthcare environment preferred.
• Demonstrated expertise in quantitative and qualitative data analysis, root cause analysis, performance improvement planning, and driving measurable quality outcomes preferred.
• Proven ability to lead cross-functional quality initiatives, facilitate executive-level discussions, and partner effectively with health plan leadership, provider organizations, and enterprise stakeholders preferred.

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.

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.

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.

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 and Influenza. 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 should submit the following form: Accessibility Accommodation Request Form and a member of the team will be in contact. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13, the posting will automatically come down on 3/12 at 11:59:59 PM. In other words — the job is posted until 3/13, not through 3/13.