Clinical Quality Program Manager

Anticipated End Date:

2026-05-19

Position Title:

Clinical Quality Program Manager

Job Description:

Shift: Monday – Friday; 8:00am – 5:00pm PST

Location: Walnut Creek, CA preferred *Candidates must be within the state of California*

Hybrid 1: This role requires associates to be in-office 1 day 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. Internal candidates may be considered with a confirmed virtual exception on file.

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 an accommodation is granted as required by law 

The Clinical Quality Program Manager is responsible for serving as a liaison with and overseeing the quality improvement activities/projects/programs for one or more states within a major line of business.

How you will make an impact:

• Leads state level quality strategy meetings, develops a quality plan, and ensures integration of quality into the overall business process.
• Works with the clinical intervention team to design studies to identify barriers to medical interventions.
• Ensures that study methodology is sound and appropriate reporting is in place.
• Develops performance improvement plans and oversees the clinical quality improvement activities/projects to improve the quality of care for members.
• Assures compliance with corporate QI work plans.
• Assures that all QI activities are relevant to the needs of targeted population.
• Maintains effective 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 data analysis results.
• Participates in and provides input to the development of new product designs for major line of business.
• Oversees the implementation of new initiatives.
• Leads interactions with regulators or oversight entities.
• Oversees quality improvement activities for the largest, most complex state programs.

Minimum Requirements:

• Requires a BS in health administration, nursing, or a related clinical field; 4 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 unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing) is preferred.
• Experience with NCQA and HEDIS strongly preferred
• Knowledge of DMHC and/or DHCS health plan regulations strongly preferred

For candidates working in person or virtually in the below location(s), the salary* range for this specific position is $98,808.00 to $154,656.00

Locations: California

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.

Job Level:

Non-Management Exempt