HEDIS Clinical Quality Program Manager
Elevance Health

Atlanta, Georgia


JR132653 HEDIS Clinical Quality Program Manager

Location: This position requires you to reside within 50 miles (and 1 hour commute) of any open, relevant Elevance Health location AND as part of our Hybrid 1 Work Strategy, you are required to work from your local office location a minimum of 1 day/week.

The HEDIS Clinical Quality Program Manager is responsible for serving as a liaison with and overseeing the HEDIS Roadmap Section 5 quality improvement activities/projects/programs for one or more states within a major line of business. Primary duties may include, but are not limited to:

  • Leads HEDIS Section 5 quality strategy meetings, develops a workplan, and ensures management of supplemental data processes.
  • Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of care for members.
  • Assures compliance with corporate QI work plans and HEDIS audit timelines.
  • Manages workplan, timelines, and coordination with other business areas on data collection, documentation, and audit guidelines.
  • Maintains effective documentation of process documentation to meet regulatory and Accreditation Standards.
  • Provides oversight to assure accurate and complete quantitative analysis of clinical data and presentation of data analysis results.
  • Participates in and provides input to the development of new product designs for major line of business.
  • Oversees the implementation of new initiatives.
  • Leads interactions with auditors and regulators or oversight entities.

Minimum Requirements:
  • BS in health administration, nursing, or a related clinical field; 4 years of health care quality or data analysis experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Qualifications:
  • Experience with the HEDIS submission process including the NCQA HEDIS Roadmap and Section 5 Supplemental data process and documentation.
  • Technical experience in HEDIS data collection guidelines.
  • Regulatory Compliance: In-depth understanding of regulatory standards and guidelines pertinent to healthcare data and quality reporting
  • Experience working with Medicaid and Medicare plans a plus.



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