Program Manager – LTSS
Elevance Health
full-time
Posted on:
Location Type: Hybrid
Location: Norfolk • Florida • Iowa • United States
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About the role
- Provide program management supporting LTSS HEDIS and quality activities across Medicaid LTSS markets
- Support end-to-end LTSS HEDIS operations, including data collection, validation, reporting, and audit readiness in alignment with contractual and regulatory requirements
- Support LTSS markets in maintaining compliance with NCQA LTSS Distinction standards and evolving CMS HCBS Quality Measure Set requirements under the Medicaid Access Final Rule
- Support LTSS HEDIS data logic, mapping, and measuring specifications, accounting for state-specific assessment tools, systems, and contractual nuances
- Partner with internal stakeholders and market teams to ensure accurate, timely, and compliant LTSS quality reporting aligning audit and performance teams across all participating states
- Support annual LTSS HEDIS audits, including review and oversight of member record reviews, IRR reviews, and overreads
- Support implementation and integration of new LTSS quality measures, assessing operational impact, data availability, validation requirements, and audit implications
- Identify risks related to compliance, data integrity, audit readiness, and operational capacity, and proactively develop mitigation strategies
- Drive process improvement, documentation, and standardization to improve consistency, efficiency, and quality outcomes across markets
- Provide backup coverage and business continuity for the LTSS COE Quality Program Director
- Develop and deliver training, guidance, and technical support to markets and internal teams on LTSS Quality requirements and best practices
- Monitor regulatory changes and emerging requirements to ensure the LTSS COE remains proactively compliant and audit-ready
- Support continuous quality improvement initiatives to strengthen quality performance, member surveys, state evaluations, and contract compliance
Requirements
- Requires a BA/BS
- minimum of 5 years external client facing experience in program/project management
- 5-7 years of LTSS experience (preferred)
- Experience conducting case management audits (preferred)
- Experience analyzing data and quality data reviews (preferred)
- Experience developing and implementing quality projects (such as PIPs or Quality Assessment and Process Improvement – QAPI) (preferred)
- Experience supporting LTSS Quality programs such as LTSS HEDIS, LTSS Distinction and CMS LTSS Quality Measures preferred
- Medicaid HEDIS and Medicare Stars knowledge/experience (preferred)
- Six Sigma Certification (preferred)
Benefits
- merit increases
- paid holidays
- Paid Time Off
- incentive bonus programs
- medical benefits
- dental benefits
- vision benefits
- short and long term disability benefits
- 401(k) +match
- stock purchase plan
- life insurance
- wellness programs
- financial education resources
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
data collectiondata validationdata reportingaudit readinessLTSS HEDIS operationsquality measure implementationcase management auditsdata analysisquality project developmentquality data reviews
Soft Skills
program managementstakeholder partnershipprocess improvementdocumentationtraining developmentguidance provisionrisk identificationmitigation strategy developmentcommunicationorganizational skills
Certifications
Six Sigma Certification