Manager Clinical Quality (HEDIS)

Manager Clinical Quality _CareBridge Health_ _is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services._ LOCATION : This position requires 3 days per week in-office. You must be within a commutable distance of one of our aligned offices. HOURS : General business hours, Monday through Friday. (Core hours: 8-5) _Hybrid 2:_ _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._ _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 accommodation is granted as required by law._ The Manager Clinical Quality is responsible for managing the day-to-day activities of one or more clinical quality program components which may be related to HEDIS reporting, NCQA accreditation and/or other quality assurance related activities. Primary duties include, but are not limited to: + Implements and evaluates current processes including operational statistics, service standards and process improvement initiatives. + Provides oversight in the planning, implementation and coordination of health care audits to ensure high quality, cost effective care. + Participates in internal and external quality review activities. + Manages and oversees quality assurance activities, which may include, but is not limited to: + managing the production, analysis, and submission of the annual HEDIS report; + overseeing community health promotion and disease management initiatives in each state in the region; + coordinating audit activities with other regions; managing achievement and maintenance of NCQA accreditation; + scheduling all information for surveys, conducting mock audits, and providing consultation to business units and team leads as regards NCQA standard issues. + Hires, trains, coaches, counsels, and evaluates performance of direct reports. Required Qualifications + Requires BS in nursing or a health care related field and minimum of 3 years of managed care experience which includes a minimum of 2 years supervisory experience; or any combination of education and experience, which would provide an equivalent background. + Certification and/or license appropriate to field of specialty is required. Preferred Qualifications + Experience in program development and knowledge of the quality process and QI techniques strongly preferred. + 3+ years of experience in clinical quality (HEDIS/Stars). + 3+ years of patient-facing experience. + Strong experience with EMR, medical records, or in patient-facing roles within any healthcare environment. + Significant experience in clinical data collection, abstraction, or validation. + Microsoft Office proficiency (Word, Excel, PowerPoint & Outlook) + Experience with clinical systems such as electronic medical records, care management, or population health management. + Bilingual skills are very helpful for this role. + Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. 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 u2013 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 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. Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 Florida Agency for Health Care Administration (.

Created: 2026-04-09