• Job Description

  Req#: R-46482

  Job Responsibilities

  • Oversee functions performed by separate teams including quality strategy, quality vendor management and quality data management
  • Serves as subject matter expert and builds bridges among project teams within the program implementation. Translates corporate objectives into program objectives and practices.
  • Develop a multi-year strategy in collaboration with organizational stakeholders including
  • Clinical Operations in each LOB, Pharmacy, Customer Service, Member Outreach, Provider Contracting, Enterprise Risk Adjustment, Provider Relations and other key stakeholders to develop relationships, resolve issues, and promote mutually beneficial strategies and processes for each product
  • Develop strategy of multiple functional teams focused on improving clinically oriented HEDIS and HOS scores as well as customer satisfaction oriented CAHPS survey results
  • Develop strategy, partnering with value-based care teams, for provider pay for performance and Quality Rewards programs aimed at aligning goals to achieve high quality care
  • Provide leadership to prioritize pipeline of projects with varying deadlines, assign projects among the team based on expectations and skill sets
  • Mentor teams on developing quality strategy to enable growth in maturity in approach to quality at an organizational level

  Job Qualifications

  Education

  • Nursing degree or degree in a health-related field required
  • Advanced degree preferred

  Experience

  • 7 years’ experience in health insurance industry with at least 3 years in Medicare Advantage products required
  • 7 years’ experience in quality improvement and quality management activities
  • 5+ years management/leadership experience required

  Skills/Certifications

  • Proficient in managing multiple priorities with specific attention to detail
  • Demonstrate strong leadership, communication, analytical, organizational, and negotiating skills to manage team and meet timelines effectively
  • Must understand Supplemental Data Collection including HEDIS, Lab, Vision, and Pharmacy as it relates to Medicare Advantage products
  • Understand competitive landscape and competitor strategies to position BCBST ahead of the market in quality performance, especially where revenue is at risk for that performance
  • Strong application skills in Word, Excel, PowerPoint, Visio and Project
  • Exceptional written and verbal communication skills, along with outstanding interpersonal, professional and diplomacy skills
  • Experience in presentations to internal and external stakeholders as well as internal and external audiences
  • Proven problem-solving ability and experience in managing multiple assignments with critical deadlines
  • Ability to work with staff from various divisions and at all job levels
  • Strong strategic planning, analytical, innovative and decision-making skills
  • Ability to prioritize workflow to meet all deadlines, often under pressure.
  • Strong decision-making skills and the willingness to take initiative and responsibility for decisions.

  Number of Openings Available:

  1

  Worker Type:

  Employee

  Company:

  BCBST BlueCross BlueShield of Tennessee, Inc.

  Applying for this job indicates your acknowledgement and understanding of the following statements:

  BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

  Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

  BCBST's EEO Policies/Notices

  BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.

  Tobacco-Free Hiring Statement

  To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results.

  Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.

• About the company

  BlueCross BlueShield of Tennessee is the largest health benefit plan company in Tennessee.

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