Manager, Provider Quality Improvement

The Provider Quality Improvement Manager develops and grows positive, long-term relationships with providers and healthcare systems to improve HEDIS measure performance to help achieve higher plan quality ratings, i.e., Stars, QRS, etc. This Manager will lead the entire life cycle of provider engagement by developing our outreach strategy and plan, creating and distributing provider communications and content for provider awareness and education purposes. Additionally, this position is responsible for implementing processes to collect, clean, and grow our provider contact data and managing the chart abstraction process. This leader must have a strategic mindset to build the vision and plan and the operational skill set to implement the strategy while driving the efficiency and scalability of the operations.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Logistics:

This is a hybrid position, Work at Home (W@H) and onsite. The onsite work location is at 4101 Percival Rd. Columbia, SC, 29229. The hours are 8:00 a.m. - 5:00 p.m. Monday - Friday.

What You'll Do:

• Ensures establishment and maintenance of excellent relationships with provider organizations.
• Leads activities related to outreach and serves as liaison to provider organizations and physician practices for assigned programs.
• Assures compliance with established quality program standards.
• Coaches practices in the collection and management of relevant program data.
• Analyzes trends regarding practice performance to inform coaching plans and opportunities for shared learning events.
• Prepares and submits various reports to management.
• Works with other relevant provider organizations and statewide groups, as applicable, to coordinate and align quality improvement efforts.

• Plans detailed special projects and leads project planning teams and workgroups using various continuous QI tools and methodologies.
• Recommends courses of action to management in the development and completion of special projects requiring quality and process improvement skills.
• Supports integration with other related initiatives.
• Identifies and facilitates opportunities to integrate project with other QI initiatives.
• Develops and disseminates relevant project materials, communications, surveys, etc.

• Provides direct practice facilitation and QI coaching to practice teams, ongoing training, consultation and monitoring to facilitate practice redesign and/or other QI improvements for designated practices.
• Provides support to existing practice coaches where those exist with ultimate goal of developing QI capacity of practice team to make improvements in practice operations and/or clinical quality.

• Develops relationships and works with consumer organizations as appropriate.
• Identifies and shares best practices through webinars, website and/or QI learning sessions.
• Stays abreast of new developments and industry trends related to best practices in clinical QI and practice transformation.
• Creates educational materials (webinars, brochures, etc.) for providers and conducts provider training as needed.
• Makes presentations to individuals and groups as indicated.

• Ensures appropriate communication with key stakeholders.
• Works with health program staff to create and update web-based communications and information.
• Contributes to health programs and project communications as appropriate.

• Responsible for clinical oversight within the HEDIS project, including but not limited to medical record review, measure training, auditing, data entry, report creation, and other related duties.

To Qualify for This Position, You'll Need:

• Bachelor's degree in any major OR associate's degree and two (2) years of work-related experience OR four (4) years of work-related experience.
• 6 years of healthcare system management, quality improvement, provider network, health claims management or a combination of these. 2 years' experience with direct health programs. 2 years project coordination experience. Leadership experience. (all may be concurrent).
• Knowledge/understanding of automated medical management systems and claims processing systems.
• Experience in health care office environment with demonstrated responsibility for process improvement and quality improvement.
• Knowledge of quality improvement concepts, and ability to learn models and methods including clinical practice transformation models and methods.
• Excellent verbal communication and presentation skills.
• Ability to demonstrate excellent writing and written communication skills.
• Excellent relationship management skills.
• Ability to work independently and to collaborate with teams of individuals in diverse settings, with solution-oriented approach.
• Good judgment.
• Strong leadership skills.
• Demonstrated customer service and organizational skills.
• Ability to persuade, negotiate, or influence others.
• Analytical or critical thinking skills.
• Ability to handle confidential or sensitive information with discretion.
• Working knowledge of project management tools.
• Microsoft Office.

We Prefer That You Have:

• Bachelor of Science in Nursing (BSN) and be a licensed registered nurse
• 3+ years of healthcare operations experience in HEDIS clinical quality and process improvement.
• Well-versed with NCQA's HEDIS data submission processes and audits
• Knowledge of CMS Quality Ratings, Stars ratings and NCQA accreditation measurements and methodologies.
• Experience in provider education programs.
• Working knowledge of CMS Risk Adjustment requirements.

What We can Do for You:

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave - the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.
• Incentive Plan.
• Merit Plan.
• Continuing education funds for additional certifications and certification renewal.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information.

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.