Hybrid Program Manager – LTSS

at Elevance Health

• Job title: Program Manager – LTSS
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: Not specified
• Degree requirement: Bachelor's Degree
• Location requirements: Hybrid, Norfolk, United States

About the role

• Program Manager managing LTSS HEDIS and quality activities across Medicaid LTSS markets. Collaborating with stakeholders for compliance and quality reporting across various states.

Responsibilities

• 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