Senior Manager, Accreditation, Quality

🕒 August 4

🏢🏡 Washington, D.C. – Hybrid

💵 $149.5k - $202.1k / year

⏰ Full Time

🟠 Senior

👔 Manager

👻 Ghost score 1%

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Blue Cross Blue Shield Association

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1960

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross Blue Shield Association is an association of independent, locally operated Blue Cross and Blue Shield companies dedicated to providing affordable and comprehensive healthcare insurance plans. It offers a wide range of health plans for individuals, families, and employers, including Medicare options. Blue Cross Blue Shield Association is committed to promoting health equity and supporting mental health initiatives, aiming to make healthcare easy, affordable, and accessible for everyone. The association is active in health care research and advocates for a more equitable health system.

📋 Description

• Manage the Quality and Accreditation Operations department, its products, and deliverables • Develop organizational strategy to improve Quality of Care, Customer Service and Resource Use measures • Support BCBSA and Plans with primary division initiatives and accreditor requirements • Provide vision for continually improving the health of the total FEP membership • Serve as subject matter expert for quality improvement, Plan operations, FEP operations, and accreditor standards and operations • Incorporate clinical insights into program development and member communications • Provide clinical support to various FEP departments • Direct and lead the department while managing day-to-day and emerging needs and issues • Monitor HEDIS and NCQA and URAC requirements and translate standards into FEP and Plan responsibility tasks • Set strategic direction and policies for accreditation operations and QCR improvement • Develop and implement tactical programs to improve member care and service • Interact with Plan medical management staff, senior Association staff, and vendors • Develop services, supports, and artifacts that increase value for Plans and customers • Lead project initiatives and collaborate with cross-functional leads • Maintain FEP accreditation Responsibility Matrices and Work Plan • Monitor deliverables from departments and vendors and ensure compliance with accreditor standards • Develop presentation content for conferences, oversight groups, and town hall calls • Serve as conduit of customer information to BCBSA staff • Develop annual budgets and project determinations for accreditation operations and the Quality Oversight Group • Estimate department staff time and review department queries and information in the Plan budgeting process • Lead and manage a team, driving performance management, professional growth, inclusion, motivation, and alignment with organizational goals

🎯 Requirements

• Bachelor's Degree in a related discipline, Registered Nurse, equivalent clinical discipline, or equivalent work experience • 7+ years of experience in the healthcare industry with progressive responsibility in project management • In-depth knowledge of healthcare, including managed care, provider reimbursement, contracting, population health, barriers to care, and quality • Familiarity with healthcare improvement literature • Ability to interpret empirical medical studies and apply concepts to FEP and Plan applications • Subject matter expertise in HEDIS, NCQA, and URAC accreditation standards and processes • Ability to provide clinical and technical oversight for accreditation operations and HEDIS and CAHPS quality improvement, including research • Experience leading significant cross-functional work with multiple subject matter experts and functional teams • Excellent project management skills • Ability to design and interpret quantitative and qualitative member research • Experience developing and reviewing qualitative research scripts and editing study reports for accreditor-standard compliance • Excellent interpersonal, presentation, written, public speaking, and communication skills • Advanced PowerPoint skills • Ability to manage relationships with internal functional areas and Plan customers • Technical proficiency with information technologies, including Microsoft Office and PowerPoint presentations

🏖️ Benefits

• Annual bonus incentive pay • Paid time off • 11 holidays • Medical insurance • Dental insurance • Vision insurance • Generous 401(k) matching • Lifestyle spending account • Work-life flexibility • Well-being programs • Commitment to community • Inclusive workplace culture