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Director Quality Management/Improvement

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.

Minimum Requirements:

+ 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.

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.

Who We Are

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.

How We Work

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 may contact [email protected] for assistance.

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.