A proud member of the Elevance Health family of companies, Carelon Behavioral Health, formerly Beacon Health Options, offers superior clinical mental health and substance use disorder management, a comprehensive employee assistance program, work/life support, specialty programs for autism and depression, and insightful analytics to improve the delivery of care.

Responsible for developing, coordinating, communicating, and implementing a strategic quality management and improvement program for a state plan.

How will you make an impact:

• Acts as the Quality subject matter expert (SME) supporting continuous quality improvement (CQI) and promotes broad understanding and collaboration across departments, and with external stakeholders.

• Is accountable for development, measurement strategy and implementation of interventions that support Quality Improvement Activities.

• Leads development of performance improvement plans and evaluation program.

• Links strategic efforts with clinical and network to improve experience of care and services of members.

• Oversees quality complaints and grievances and reporting to the state.

• Leads audits of delegated services and oversees compliance activities to ensure regulatory and compliance standards are met.

• Responsible for all KPIs in the contract related to Quality.

• Leads Health Employer Data Information Sets (HEDIS) reporting and the development of action plans to achieve target improvement goals.

• Supports the External Quality Review Organization (EQRO) reporting and state audit processes.

• Provides leadership for QM representation in new business activities.

• Ensures compliance with National Committee for Quality Assurance (NCQA) standards or other accrediting bodies.

• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

Monday -Friday 9 am - 5:30 pm EST*

*Candidate MUST be a resident of Maryland*

*This position is hybrid. Candidate must be willing to report to the office a minimum of 1 day a week.*

Minimum Requirements:

• Requires a BA/BS in a health or business-related field.

• 10 years of experience in a healthcare environment, including prior management experience; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• MSN, MPH, or MPA preferred.

• Minimum of seven (7) years of cross-functional operational experience, three (3) of which using Contractor’s System strongly preferred.

• Minimum of five (5) years’ experience in QA of Medicare/Medicaid coverage and reimbursement regulations and compliance preferred.

• ASAM experience a plus

• Licensed in the area of Behavioral Health STRONGLY preferred.

• CQM experience in a Managed Care Organization preferred.

• Population health management and/or clinical quality program development experience preferred.