Medicaid Quality Management Director

Elevance Health

Director overseeing clinical quality management and improvement programs for a major healthcare organization. Responsible for HEDIS, CAHPS quality improvement, and regulatory compliance.

Posted 7/13/2026full-timeSeattle • California, Illinois, Kansas, Washington • 🇺🇸 United StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical quality management and improvement, with a strong focus on HEDIS and CAHPS initiatives. Proven ability to lead cross-functional teams and manage state-regulated contracts while ensuring compliance with CMS and NCQA standards.

Highest-signal resume keywords

Clinical Quality ManagementHEDIS ImprovementCertified Professional in Healthcare Quality (CPHQ)NCQA AccreditationData Integration

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Quality ImprovementProcess ImprovementData ReportingClinical WorkflowsBehavioral Health Care Delivery

Soft Skills

CollaborationLeadershipCommunication

Tools & Technologies

Reporting InfrastructureAnalytics Tools

Certifications & Qualifications

Certified Professional in Healthcare Quality (CPHQ)HCQM Certification

Industry Keywords

Healthcare Effectiveness Data Information Set (HEDIS)Centers for Medicare and Medicaid Services (CMS)Accrediting RequirementsState-Regulated ContractsMember Safety Events

About the role

Key responsibilities & impact

Responsible for driving the development, coordination, communication, and implementation of a strategic clinical quality management and improvement program within assigned health plan
Work with the regional head of quality management to direct clinical quality initiatives such as HEDIS and CAHPS quality improvement
Maintain expert knowledge of current industry standards and quality improvement activities
Serve as a resource for the design and evaluation of process improvement plans
Collaborate with leaders in developing, monitoring, and evaluating Healthcare Effectiveness Data Information Set (HEDIS) improvement action plans
Monitor and report quality measures per state, Centers for Medicare and Medicaid Services (CMS), and accrediting requirements

Requirements

What you’ll need

Requires BA/BS in a clinical or health care field (i.e. nursing, epidemiology, health sciences)
Minimum 5 years progressively responsible experience in a health care environment
Strong BH quality management experience preferred
Certified Professional in Healthcare Quality (CPHQ) or HCQM certification preferred
Demonstrated expertise with NCQA accreditation strongly preferred
Extensive experience leading large-scale, cross-functional initiatives involving data integration, reporting infrastructure, and partnership with IT and analytics teams preferred
Proven ability to lead in a highly matrixed environments
Experience managing state-regulated contracts with high reporting volume preferred
Deep familiarity with clinical workflows, member safety events, and behavioral health care delivery models preferred

Benefits

Comp & perks

Paid Time Off
Incentive bonus programs
Medical, dental, vision insurance
Short and long-term disability benefits
401(k) + match
Stock purchase plan
Life insurance
Wellness programs
Financial education resources