Director National Quality Management-Behavioral Health Background Strongly Preferred!!

• Date Posted:Jun 05, 2023
• Req #: JR66350
• Type: Full time
• Job Family: Customer Care

Location:

• North Carolina, North Carolina
• West Virginia, West Virginia
• National +50 Miles away from nearest PulsePoint, National +50 Miles away from nearest PulsePoint
• South Carolina, South Carolina
• Florida, Florida
• Virginia, Virginia
• Illinois, Illinois
• Georgia, Georgia

Description
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.
Summary
Leads Quality operations and execution of the quality strategy across all lines of business within assigned territory. Provides support across multiple products, clients, and divisions on the delivery of NCQA accreditation requirements, HEDIS intervention deployment, and contract compliance.
Serves as primary client facing quality liaison and actively participates in joint operating committees with clients. Responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program that meets client expectations.
How You Will Make An Impact

• Provides Quality thought leadership to Sales teams/RFPs, and creates quality-related articles for members and providers.
• Develops, implements and leads an industry leading quality improvement program consistent across our products, ensuring that all NCQA, HEDIS, and client requirements are met and/or exceeded.
• Implements corporate policies and creates local quality addenda and SOPs when needed.
• Produces QM documents, including tracking and updating Work Plan activity progress.
• Tracks performance of Core Performance Indicators (CPIs).
• 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 in the charter of Quality Improvement Activities (QIA) to support accreditation.
• Leads Quality projects in collaboration with clients.
• Monitors Service Level Agreements (SLA) relating to quality and implements and monitors Corrective Action Plans (CAPs) in collaboration with internal stakeholders, clients, and providers.
• Leads and/or chairs quality committees.
• Implements and monitors CAPs related to Corporate Quality as well as external client delegation and regulatory audits for accreditation readiness.
• Collaborates with health plan clients on HEDIS measures measurement and improvement opportunities. Collaborates with Corporate Quality on HEDIS rate production and client deliverables.
• Produces and oversee production of client and contractual reports and reports required for meeting accreditation standards.
• Oversee QIA program development.
• Ensures ongoing compliance with accreditation (NCQA and URAC) standards.
• 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.

Preferred Skills, Capabilities And Experiences

• Extensive experience in behavioral health strongly preferred.
• Proficient to advanced knowledge in Behavioral Health HEDIS interventions, member experience, member safety, and innovation implementation strongly preferred.
• Extensive experience working in a highly matrixed environment strongly preferred.
• Current, active, unrestricted license is preferred.
• MS or advanced degree in a health care related field preferred.
• Experience leading a quality improvement team within an NCQA MBHO framework strongly preferred.

Please be advised that Elevance Health only accepts resumes from agencies that have a signed agreement with Elevance Health. Accordingly, Elevance Health is not obligated to pay referral fees to any agency that is not a party to an agreement with Elevance Health. Thus, any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.
Be part of an Extraordinary Team
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. A Fortune 20 company with a longstanding history in the healthcare industry, we are looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. You will thrive in a complex and collaborative environment where you take action and ownership to solve problems and lead change. Do you want to be part of a larger purpose and an evolving, high-performance culture that empowers you to make an impact?
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.
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 – and Elevance Health approves – a valid religious or medical explanation as to why you are not able to get vaccinated that Elevance Health is able to reasonably accommodate. Elevance Health will also follow all relevant federal, state and local laws.
Elevance Health has been named as a Fortune Great Place To Work in 2022, has been ranked for five years running as one of the 2023 World’s Most Admired Companies by Fortune magazine, and is a growing Top 20 Fortune 500 Company. To learn more about our company and apply, please visit us at careers.ElevanceHealth.com. 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 [email protected] for assistance.
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