Location:

Within 50 miles of a PulsePoint, strong preference to Cerritos, CA.

Summary:

Looking to make a monumental impact in healthcare? Our Staff VP Carelon Health Stars acts as the driving force behind the development, coordination, communication, and strategic execution of top-tier clinical quality management programs for multi-state Medicare and Medicaid markets within Carelon Health.

As a pivotal role within our organization, you'll have the chance to spearhead quality-enhancement campaigns (HEDIS) and launch initiatives that support STARS improvement. Your expertise and leadership will guide Carelon Health to ensure high-quality scores, generating significant revenue enhancements within the markets.

Primary duties may include, but are not limited to:

• Drives provider performance improvement for HEDIS, STARS, State Contract Quality & Pay for Performance/Withhold and Medicare Quality metrics.

• Foster unity, communication, and collaboration enterprise-wide, promoting the integration and utilization of evidence-based practices.

• Advocate for a visionary business approach, leading process improvement activities throughout Carelon Health.

• Identify and champion the selection of process improvement activities across Carelon Health.

• Assume a key role in Quality Management Scorecards, HEDIS, HOS and CAHPS operations.

• Develop strategic HEDIS, CAHPS, VBP goals and objectives, ensures timely completion and develops contingency plans as needed.

• Take on a leadership role in new business activities representing Quality Management.

• Uphold compliance with National Committee for Quality Assurance (NCQA) standards ensuring an utmost commitment to exceptional quality.

• Direct and empower Carelon Health QM committees and leadership meetings.

• Hire, train, coach, counsel, and evaluate performance of direct and indirect reporting staff.

Position Requirements:

• Requires BS/BA in nursing, public health, healthcare administration, business administration or other health care related field and a minimum of 8 years of experience in a health care environment.

• A minimum of 5 years of experience in a managed care organization QM role.

• A minimum of 5 years of experience working with government sponsored health care programs; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Medicare, Medicaid, Commercial Healthplan experience

• STARS and HEDIS expertise and understanding patient experience around quality

• Experience leading provider group/health plan to a higher STARS rating.

• Certified Professional Healthcare Quality (CPHQ).

• MS/MA

For candidates working in person or remotely in the below locations, the salary* range for this specific position is $153,600 to $276,480

Locations: California; Colorado; Nevada; New York; Washington State; Jersey City, NJ

In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the company. The company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws .

• The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.