Clinical Operations & Physicians
Manager, Quality Improvement
Arlington, VA, United States

Your Future Evolves Here

Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans.

Are we growing? Absolutely--62% in year-over-year revenue growth through 2015. Are we recognized? Definitely. We’re 12th on Forbes’ list of America’s Most Promising Companies for 2015, one of “Becker’s 150 Great Places to Work in Healthcare” in 2016, and our CEO was number one on Glassdoor’s 2015 Highest-Rated CEOs for Small and Medium Companies. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.

Who You’ll Be Working With:

Evolent Health is looking for a Manger, Quality Improvement to be a key member of the Quality and Performance Improvement team.  This position supports the quality functions for Evolent and health plan clients as he/she assists with the designs, build and management of the health plan quality programs that meet CMS and NCQA requirements. The QI Manager plays a key role supporting internal and external quality improvement structure, process, and efficiencies.    

What You’ll Be Doing:

  • Assist with launch and implementation activities of client health plan quality programs.
  • Prepare reports for internal committees (e.g., QIC,); prepare and maintain minutes.
  • Maintain, review and participate in the revision of departmental and corporate policies, procedures, and protocols.
  • Manage all client quality of care cases, according to the policies and procedures. Review with the Market Medical Director, ensure tracking is complete and all required timeframes are met.
  • Support initial and on-going compliance with state and federal quality improvement requirements; specifically from Chapter 5 of the Medicare Managed Care Manual, internal and new client health plans.
  • Ensure internal and external client Quality Improvement Program description templates are compliant with CMS and NCQA.
  • Assist in the implementation of review/audit plans, self-assessments and other activities to monitor and track ongoing compliance with NCQA standards, federal and state laws, and Medicare/Medicaid rules and regulations.
  • Coordinate aspects of the audit program, including maintaining audit files, developing an audit timeline, analysis of audit data, and accurate reporting of all audit results.
  • As needed, assist with HEDIS chart review, and NCQA readiness review activities to ensure all requirements are met.

The Experience You Need (Required):

  • Bachelors of Science in nursing - or a licensed practical nurse.
  • 3+ years clinical or health plan management experience, with understanding of performance measures (e.g., NCQA/HEDIS measures etc.)
  • 2+ years Medicare and/or dual eligible quality management experience in a managed care setting
  • 2+ years of Administrative experience in a health care or managed care environment and project management experience preferred
  • Excellent analytical, verbal, written, organizational and interpersonal skills.
  • Intermediate level proficiency with Microsoft Office applications and data management reporting.
  • Knowledge of QI/CQI principles, CMS requirements and regulations, and NCQA standards and regulations

Finishing Touches (Preferred):

  • Experience with analyzing HEDIS, CAHPS, HOS and Medicare 5-Star rating data.
  • Masters in health-related field 

Evolent Health is an Equal Opportunity/Affirmative Action Employer


Clinical Operations & Physicians
Arlington, VA, United States
Clinical Operations & Physicians
Arlington, VA, United States