Anticipated End Date:

2026-03-10

Position Title:

Program Manager-LTSS

Job Description:

Program Manager

Hybrid 1: This role requires associates to be in-office 1 - 2 days 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. Alternate locations may be considered if candidates reside within a commuting distance from an office.

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 Program Manager is responsible for the development and ongoing management of one or more multi-year external client facing programs within a business unit. Program managers typically support business strategies through an integrated portfolio of external client facing projects or initiatives. A program manager may have responsibility for a piece of a larger enterprise/regional external client facing program.

How you will make an impact:

Primary duties may include, but are not limited to:

• 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.

Minimum Qualifications:

Requires a BA/BS and minimum of 5 years external client facing experience in program/project management; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• 5-7 years of LTSS experience.
• Experience conducting case management audits.
• Experience analyzing data and quality data reviews.
• Experience developing and implementing quality projects (such as PIPs or Quality Assessment and Process Improvement – QAPI).
• Experience supporting LTSS Quality programs such as LTSS HEDIS, LTSS Distinction and CMS LTSS Quality Measures preferred.
• Medicaid HEDIS and Medicare Stars knowledge/experience.
• Six Sigma Certification.

Job Level:

Non-Management Exempt

Workshift:

Job Family:

BSP > Program/Project

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact elevancehealthjobssupport@elevancehealth.com for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.