The role is responsible for management of the Quality and Accreditation Operations department, its products, and deliverables. Responsible for organization strategy for improving the Quality of Care, Customer Service and Resource Use (QCR) measures, incorporating FEP capacity and Plan needs. Serves as resource to BCBSA and Plans in support of primary division initiatives and accreditor requirements. Provides a vision to continually improve the health of the total FEP membership. Functions as content expert for quality improvement, Plan operations, FEP operations and accreditor standards and operations. Incorporates clinical insights into program development and member communications and provides clinical support to various FEP departments.<br><br><ul><li>Provides direction and leadership for the department and manages day-to-day and emerging needs/issues. Keeps current of HEDIS, NCQA, URAC requirements, and translates new standards and measurement requirements to FEP and Plan responsibility tasks. Sets the strategic direction and policies of the accreditation operations team and for QCR improvement. Participates in the development and implementation of tactical programs to improve member care and service and advance the core objectives of the BCBSA. Interacts significantly with high level Plan medical management staff, senior level staff within divisions at the Association, and vendors. Develops supports and artifacts which increase the value of services for Plans and customers.</li><li>Provides leadership and direction in the implementation of project initiatives to ensure goals are met and to provide value to Plans and customers. Collaborates with cross functional leads. Maintains the FEP accreditation Responsibility Matrices and FEP Accreditation Work Plan. Monitors deliverables from other departments and vendors. Ensures compliance with accreditor standards.</li><li>Develops presentation content for the FEP National Conference, Business Operations and Technical Conference, the Quality Oversight Group, the HEDIS Improvement Team Town Hall Call and the Accreditation Town Hall Call. Serves as a conduit of information from customers to appropriate BCBSA staff.</li><li>Development of annual budget and project determinations related to accreditation operations and the Quality Oversight Group. Estimates department staff time for other functional areas. Annually reviews and assures the accuracy of department queries and information in the Plan budgeting process.</li><li>Lead and manage a team with the aim of driving effective performance management, fostering professional growth, and creating a positive and inclusive work environment. This role is dedicated to utilizing strong leadership and communication skills to motivate and inspire team members, ensuring they are aligned with and committed to achieving the organization’s goals.<br><br></li></ul><strong>The Posting Range For This Position Is<br><br></strong>127,500.00 - 184,875.00<br><br><strong>Qualifications<br><br></strong><strong>Education <br><br></strong><ul><li>Required Bachelor's Degree in related discipline or Registered Nurse, equivalent clinical discipline or equivalent work experience<br><br></li></ul><strong>Experience<br><br></strong><ul><li>Required 7+ Years experience in the health care industry with progressive responsibility in project management<br><br></li></ul><strong>Knowledge Skills And Abilities<br><br></strong><ul><li>In-depth knowledge of the healthcare industry, including managed care, provider reimbursement, contracting, population health, barriers to care and quality.</li><li>Familiarity with health care improvement literature.</li><li>Able to interpret empirical studies from the medical literature and apply the concepts to the FEP and Plan applications.</li><li>Subject matter expert in HEDIS and NCQA and URAC accreditation standards and processes.</li><li>Ability to perform clinical and technical oversight for accreditation operations and HEDIS and CAHPS quality improvement, including research.</li><li>Demonstrated experience in leading significant cross-functional work with multiple subject matter experts and functional teams.</li><li>Excellent project management skills.</li><li>Ability to design and interpret quantitative and qualitative member research, including developing and reviewing qualitative research scripts and editing study reports for compliance with accreditor standards</li><li>Excellent interpersonal and communication skills, including both presentation and written. Advanced PowerPoint skills a requirement.</li><li>Ability to manage relationships, particularly with internal functional areas and with Plan customers.</li><li>Technical proficiency with information technologies (e.g. Microsoft Office and in particular, PowerPoint presentations).</li><li>Public speaking and presentation skills.<br><br></li></ul>The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range and this hiring range may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for <em>annual bonus incentive </em>pay.<br><br>We offer a comprehensive package of benefits <em>including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits </em>to eligible employees.<br><br>Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.<br><br>