Director Quality Management​/Improvement

Join to apply for the Director Quality Management/Improvement role at Elevance Health.

This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations can be considered.

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 an accommodation is granted as required by law.

The Director Quality Management/Improvement is responsible for developing, coordinating, communicating, and implementing a strategic quality management and improvement program for a state plan.

** Candidate MUST be domiciled and licensed in the state of Massachusetts*
* How will you make an impact

• Develops, deploys and measures behavioral health strategic quality plan for statewide managed care contract and crisis line services.

• 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 Quality Measure Improvement Plan including HEDIS, Health Equity and other state defined quality measurement intervention program. This includes development of action plans, deployment of interventions and ongoing monitoring of performance. Responsible for overall improvement of incentive program based on measure improvement.

• Supports the External Quality Review Organization (EQRO) reporting and state audit processes.

• Provides leadership for QM representation in new business activities and acts as liaison between company and state partners.

• Ensures compliance with National Committee for Quality Assurance (NCQA) behavioral health and health equity standards for managed care contract and compliance with American Association of Suicidology (AAS) and International Council of Helplines (ICH) accreditations for crisis line services.

• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

• 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

• Extensive experience leading quality performance improvement, implementation, and program development to support accreditation including developing, implementing, monitoring and tracking performance of quality programs strongly preferred.

• Current, active, unrestricted license in MSW, LMHC, APRN, or MFT strongly preferred.

• Advanced knowledge of HEDIS interventions to include clinical intervention strongly preferred.

• Robust capabilities to analyze data insights and strategically implement interventions to address and rectify situations when targets are not being met strongly preferred.

• CQM experience in a managed care organization preferred.

• Population health management and/or clinical quality program development experience preferred.

• 3-5 years of managing direct reports strongly preferred.

• 5 years direct management of quality programs strongly preferred.

For candidates working in person or virtually in the below location(s), the salary
* range for this specific position is $135,520 to $212,520

Locations:
Massachusetts

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