Resp & Qualifications
The Quality Manager leads a team of associates responsible for defining, measuring, analyzing, and evaluating population health, while prioritizing, developing, and operationalizing innovative initiatives to improve the quality of care and experience, resulting in industry-leading outcomes at a population level.
Manages, develops, and leads a team in a matrixed organization environment
Monitors, measures, and ensures compliance with accreditation requirements, quality performance methodologies, and applicable state, local, and federal regulations
Formulates and implements the enterprise strategy for population health, quality, and member experience improvement
Drives the progress and completion of innovative initiatives and evaluates their effectiveness
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education Level: Bachelor's Degree
Education Details: population health, public health, healthcare administration, business administration, health policy, economics, statistics, mathematics, data science, or a related field;
Experience: 5 years experience in a healthcare, public health, health insurance, quality/process improvement or data management business environment; inclusive of 3 years data analytics experience working with large data sets to answer clinical, operational, or business questions; prior experience with HEDIS, CAHPS, NCQA, quality measurement, population health analytics, and value-based reimbursement models highly valued
1 year supervisory experience or demonstrated progressive leadership experience
In Lieu of Education: In lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Training or certification in Quality or Process Improvement Methods
Knowledge, Skills and Abilities (KSAs) Proficiency
Ability to perform qualitative and quantitative data analyses and create innovative strategies and work with colleagues to address findings Advanced
Ability to learn the technical aspects of collection and reporting of both administrative and clinical aspects of quality measures. Advanced
Ability to conduct advanced analytics using SQL, Python, R, or similar; fluent in Excel. Expertise with healthcare claims, survey, clinical, and health data. Proficient
Strong computer skills to include Microsoft Office - Excel, Word, Power Point, Outlook Advanced
Ability to mentor and coach associates to accomplish goals, provide objective evaluation of associate performance, and implement strategies to improve individual and team-based performance as needed.
Department: Accreditation & Medical Programs
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 6/18/21
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship
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