Blue Cross & Blue Shield of Rhode Island
Lead Quality Management Analyst-DSNP
Blue Cross & Blue Shield of Rhode Island, Providence, Rhode Island, us, 02912
Overview
Lead Quality Mgmt Analyst-DSNP role at
Blue Cross & Blue Shield of Rhode Island . Pay Range:
$92,700.00 - $139,100.00 Please email
HR_Talent_AcquisitionTeam@bcbsri.org
if you are a candidate seeking a reasonable accommodation for the application and/or interview process. BCBSRI values a diverse and inclusive workplace with flexible work arrangements and strong emphasis on employee well-being and development. Essential Job Functions
Lead the management of behavioral health and clinical quality programs to support an integrated, cost-effective care model that enhances member quality of life. Mentor staff by setting goals, evaluating performance and conducting regular chart/call audits. Oversee program operations, research and recommend changes and improvements with a primary focus on member outcomes. Triage program issues to internal stakeholders for resolution and process improvement. Establish and monitor key performance metrics for quality programs. Ensure processes to report on and monitor metrics closely and recommend mitigating actions when risk exists. Collaborate across departments to align quality initiatives with strategic goals and ensure successful project outcomes. Ensure department complies with applicable regulatory guidelines including NCQA, DOH, CMS, URAC, HIPAA, State of RI Workers Comp Protocol, DOH, EOHHS, etc. Train the clinical team on the development of the member Care Plan and its effective use as a tool to drive member interactions and engagement. Qualifications
Minimum Education and Experience: Bachelor’s degree in nursing or related field, or an equivalent combination of education and experience with active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC), or a Behavioral Health license (LICSW, LMHC, LMFT) or a bachelor’s degree in health information administration or an equivalent combination of education and experience. Three to five years of experience in case management and/or disease management and up to 3-5 years’ experience with clinical quality activities. Preferred Education, Additional Qualifications And Experience: Master’s in nursing or healthcare administration or related field Experience overseeing quality improvement activities Experience overseeing program operations Knowledge of regulatory guidelines Clinical experience Possession and maintenance of Case Management Certification (CCM) within 3 years of tenure in the position Required Knowledge, Skills, And/or Abilities: Knowledge of project management methodologies Knowledge of business process improvement techniques and strategies Excellent verbal and written communications skills Ability to create corrective action plans Ability to interpret regulatory requirements and translate into business requirements Ability to lead and manage projects Ability to think creatively and drive innovation Ability to interface with employees at all levels Ability to effectively navigate ambiguous situations with limited direction Excellent organizational skills and ability to successfully prioritize multiple tasks Ability to handle multiple priorities/projects Ability to set and maintain quality standards Ability to develop and maintain effective and collaborative working relationships Strong and effective decision-making skills Ability to mentor, coach and provide guidance to others Proficiency with Microsoft Suite of products (Word, Excel, PPT) Location
BCBSRI is headquartered in downtown Providence. Flexible schedules are offered: in-office, hybrid, or remote options based on role. Permitted to reside in states listed by Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia. BCBSRI is an equal opportunity employer. The law requires employers to post notices describing Federal laws. Visit
www.eeoc.gov/know-your-rights-workplace-discrimination-illegal
to view the Know Your Rights poster.
#J-18808-Ljbffr
Lead Quality Mgmt Analyst-DSNP role at
Blue Cross & Blue Shield of Rhode Island . Pay Range:
$92,700.00 - $139,100.00 Please email
HR_Talent_AcquisitionTeam@bcbsri.org
if you are a candidate seeking a reasonable accommodation for the application and/or interview process. BCBSRI values a diverse and inclusive workplace with flexible work arrangements and strong emphasis on employee well-being and development. Essential Job Functions
Lead the management of behavioral health and clinical quality programs to support an integrated, cost-effective care model that enhances member quality of life. Mentor staff by setting goals, evaluating performance and conducting regular chart/call audits. Oversee program operations, research and recommend changes and improvements with a primary focus on member outcomes. Triage program issues to internal stakeholders for resolution and process improvement. Establish and monitor key performance metrics for quality programs. Ensure processes to report on and monitor metrics closely and recommend mitigating actions when risk exists. Collaborate across departments to align quality initiatives with strategic goals and ensure successful project outcomes. Ensure department complies with applicable regulatory guidelines including NCQA, DOH, CMS, URAC, HIPAA, State of RI Workers Comp Protocol, DOH, EOHHS, etc. Train the clinical team on the development of the member Care Plan and its effective use as a tool to drive member interactions and engagement. Qualifications
Minimum Education and Experience: Bachelor’s degree in nursing or related field, or an equivalent combination of education and experience with active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC), or a Behavioral Health license (LICSW, LMHC, LMFT) or a bachelor’s degree in health information administration or an equivalent combination of education and experience. Three to five years of experience in case management and/or disease management and up to 3-5 years’ experience with clinical quality activities. Preferred Education, Additional Qualifications And Experience: Master’s in nursing or healthcare administration or related field Experience overseeing quality improvement activities Experience overseeing program operations Knowledge of regulatory guidelines Clinical experience Possession and maintenance of Case Management Certification (CCM) within 3 years of tenure in the position Required Knowledge, Skills, And/or Abilities: Knowledge of project management methodologies Knowledge of business process improvement techniques and strategies Excellent verbal and written communications skills Ability to create corrective action plans Ability to interpret regulatory requirements and translate into business requirements Ability to lead and manage projects Ability to think creatively and drive innovation Ability to interface with employees at all levels Ability to effectively navigate ambiguous situations with limited direction Excellent organizational skills and ability to successfully prioritize multiple tasks Ability to handle multiple priorities/projects Ability to set and maintain quality standards Ability to develop and maintain effective and collaborative working relationships Strong and effective decision-making skills Ability to mentor, coach and provide guidance to others Proficiency with Microsoft Suite of products (Word, Excel, PPT) Location
BCBSRI is headquartered in downtown Providence. Flexible schedules are offered: in-office, hybrid, or remote options based on role. Permitted to reside in states listed by Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia. BCBSRI is an equal opportunity employer. The law requires employers to post notices describing Federal laws. Visit
www.eeoc.gov/know-your-rights-workplace-discrimination-illegal
to view the Know Your Rights poster.
#J-18808-Ljbffr