Quality Management/Accreditation Manager

<p>With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.</p>

Southfield, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="https://bcbsm.taleo.net/careersection/2/jobsearch.ftl?lang=en" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

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Competitive Total Compensation Package

Overview: Manage all critical elements needed to secure and maintain accreditation status, enabling organization to sell products on the health care exchange/marketplace related to PPO (preferred provider organization) and EPO (exclusive provider organization) products.
Responsibilities: <ul> <li>Manage all operational aspects of Quality Management including but not limited to planning, enforcement of project standards and timelines, auditing, problem solving, staff development and communication. Provide oversight and expertise in regards to NCQA (National Center for Quality Assurance) compliance tracking, standards and the accreditation process. Collaborate with stakeholders to resolve issues regarding compliance.</li> <li>Provide oversight to all full-time employees, contract staff and HEDIS vendors that provide services to support this unit.</li> <li>Manage file review process to ensure all communications are in compliance with NCQA standards.</li> <li>Establish and maintain communications among all project/programs stakeholders.</li> <li>Identify and implement process improvements. Develop tools for process improvements.</li> <li>Responsible for creation and implementation of training and support for all assigned business areas.</li> <li>Provide clinical support to Cultural Diversity Pilot with review of Quality Improvement (QI) plan and verification of PO plan implementation.</li> <li>Provide oversight and management of the inclusion of additional PPO customer populations into the NCQA accredited population specifically as it relates to NCQA standards as needed by business areas and new requirements.</li> <li>Manage work associated with Quality Improvement standards (QIS) associated with Marketplace products.</li> <li>Other duties as assigned.</li> </ul>
Requirements: <ul> <li>Bachelor's Degree in related field required. Master's Degree in related field considered a plus.</li> <li>Five (5) to ten (10) years' experience with health care health care accreditation specific experience related to NCQA accreditation, quality improvement expertise with solid understanding of various strategies, supplemental data to improve quality scores and direct involvement with NCQA surveys.</li> <li>Current valid and unrestricted Michigan RN license. BSN preferred</li> <li>Five (5) years clinical experience in a health care setting as a practicing registered nurse.</li> <li>Ability to work under general direction.</li> <li>Ability to work effectively in a team environment.</li> <li>Good analytical, organizational, planning, verbal and written communication skills.</li> <li>Advanced proficiency in Microsoft Office suite (Excel, Word, PowerPoint)</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <strong>SUPERVISOR RESPONSIBILITIES</strong><br /> <ul> <li>Manages departmental subordinate supervisors who supervise departmental employees as shown on the organizational chart.</li> <li>Is responsible for the overall direction, coordination, and evaluation of this unit. Also directly supervises departmental non-supervisory employees.</li> <li>Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws.</li> <li>Responsibilities include interviewing, hiring, and training employees planning, assigning, and directing work appraising performance rewarding and disciplining employees addressing complaints and resolving problems.</li> </ul> All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.