Anticipated End Date:

2025-02-24

Position Title:

Clinical Quality Program Admin-Risk Management

Job Description:

Clinical Quality Program Administrator-Risk Management

Location:  This position will work a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.

Expected Work Hours-Monday-Friday; 8am-5pm EST

The Clinical Quality Program Administrator is responsible for overseeing the quality improvement activities/projects as outlined in the Risk Management description as required by applicable law, regulations and accreditation standards. This position is for a Risk Manager, supporting the Simply Florida Health Plan. The Risk Manager is responsible for overseeing the development and implementation of the Risk Management Program, ensuring compliance with health and safety laws at federal, state, and local levels. The role involves creating and managing an incident reporting system to track and analyze adverse or critical incidents, identifying potential risks and quality care concerns, and developing strategies to minimize these risks.

How you will make an impact:

Primary duties may include, but are not limited to:

Providing training to ensure compliance with incident reporting requirements, overseeing new-hire orientation related to the incident reporting system, and analyzing patient grievances related to quality of care.Conduct systematic reviews of incident reports to identify trends and prepare comprehensive quarterly reports for health plan committees and the Board of Directors.Reporting to external regulatory bodies as required and ensuring adherence to specified reporting requirements.Ensures integration of quality into the overall business process.Oversees the clinical quality improvement activities/projects to implement appropriate clinical interventions to improve the quality of care for members.Assures compliance with Florida Risk Management plans.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.

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 active unrestricted RN license.Certified Risk Management preferred.Previous experience in utilization management, quality of care, and critical incident.Some weekend rotations required.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

QLT > Clinical Quality

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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.

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 elevancehealthjobssupport@elevancehealth.com 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.