Clinical Quality Program Administrator
Elevance Health

Job Info

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Be Part of an Extraordinary Team

Title: Clinical Quality Program Admin

Location: Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location: FL-MIAMI, 11430 NW 20TH ST, STE 300 or FL-TAMPA, 5411 SKY CENTER DR

Shift: Onsite 1-2 days/week, WFH 3-4 days/week

Build the Possibilities. Make an Extraordinary Impact.

The Clinical Quality Program Administrator is responsible for overseeing the quality improvement activities/projects as outlined in the Quality Improvement (QI) work plan and as required by applicable law, regulations and accreditation standards.

How you will make an impact:

Primary duties may include, but are not limited to:

• Ensures integration of quality into the overall business process.
• Performs assessments to identify gaps in the enterprises quality and technology assessment processes and initiates actions to correct these gaps.
• Assures accuracy and completeness of input provided to internal and external QI committees and timely implementation of appropriate interventions.
• Oversees the clinical quality improvement activities/projects to implement appropriate clinical interventions to improve the quality of care for members.
• Assures compliance with corporate QI work plans.
• Assures QI activities are relevant to the targeted population.
• Assures compliance to Practice Guideline, Delegation and Continuity and Coordination of care Standards.
• Maintains documentation of research programs to meet regulatory and Accreditation Standards.
• Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of results.
• May provide oversight to the Healthcare Effectiveness Data and Information Set (HEDIS) project team.

Minimum Requirements:

Requires a BS in health administration, nursing or related clinical field; 3 years of health care quality or data analysis experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Current unrestricted license or certification in applicable field preferred (i.e. CPHQ).
• MS in the health field (i.e. Nursing) preferred.
• Florida Medicaid plan experience highly preferred.
• MCO (Managed Care Organization) experience preferred.

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