What are the responsibilities and job description for the Clinical Program (Medicaid) Development Manager position at Elevance Health?
Clinical Program Development Manager – Medicaid Programs (JR145821)
Location: Must reside in the state of Missouri within 50 miles/1 hour commute of our St. Louis, Missouri PulsePoint.
Office Requirement: 1 day per week minimum in office work.
The Clinical Program Development Manager for Missouri Medicaid is responsible for managing clinical program development for population-based clinical quality measures, including HEDIS within a clinical area and across Medicaid line of business. This role is also responsible for overall care coordination with all stakeholders and providers involved in the care of members. Primary duties to include, but are not limited to:
Evaluates industry best practices, medical research and other resources to develop clinical programs and tools which facilitate and support quality, cost-effective care.
Develops and implements an annual plan detailing the strategies, programs and tools to be implemented.
Leads program development activities.
Develops and coordinates presentations, communications and implementation for all phases of the clinical programs/tools development and implementation.
Ensures all programs and tools are compliant with regulatory directives and state/federal laws and policies.
Identifies system needs to implement clinical programs.
Develops system requirements and ROI.
Tracks program performance and results and modifies as needed.
Provides leadership and guidance to associates involved in program development and implementation activities.
Minimum Requirements:
BA/BS in business, public health, nursing, epidemiology biostatistics, or related field and minimum of 5 years’ experience involving analyses of health care data and clinical program development; or any combination of education and experience, which would provide an equivalent background.
Preferred Qualifications:
Current Missouri RN license strongly preferred.
MS in public health, health services administration, nursing, or business administration preferred.
Knowledge of Missouri Medicaid and UM experience strongly preferred.
Project / Program Management preferred.
Knowledge of clinical data systems.
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.
