Manager AR Home Quality

Arkansas Blue Cross

Little Rock, AR

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JOB DETAILS

SKILLS

Accounts Receivable Management, Administrator Documentation, Americans with Disabilities Act (ADA), Analysis Skills, Behavioral Health, Behavioral Intervention, Budget Management, Centers for Medicare and Medicaid Services (CMS), Clinical Practices/Protocols, Clinical Support, Coaching, Cross-Functional, Customer Escalations, Data Quality, Documentation, Government, Healthcare, Healthcare Effectiveness Data and Information Set (HEDIS), Healthcare Providers, Healthcare Quality, Interpersonal Skills, Leadership, Maintain Compliance, Medicaid, Medical Records, Medicare, Medications, Microsoft Access Database, Microsoft Excel, Microsoft Office, Organizational Skills, Performance Management, Pharmacy, Project/Program Management, Public/Media/Press/Analyst Relations, Quality Management, Quality Metrics, Regulatory Requirements, Reporting Skills, Return on Investment (ROI), Staff Development, Staff Training, Strategic Analysis, Strategic Planning, Team Lead/Manager, Team Player, Time Management, Trend Analysis

LOCATION

Little Rock, AR

POSTED

1 day ago

To learn more about Arkansas Blue Cross and Blue Shield Hiring Policies, please click here. Job Summary The Manager AR Home (Medicaid) Quality directs programs for all quality measures. The incumbent collaborates with higher level leadership to develop the strategy for appropriate measures and implements programs to support meeting state requirements. The Manager is responsible for keeping the team focused on project documentation and implementation while collaborating with internal teams, vendors, and key state providers to support strategic development, drive program success, enhance analytics, and achieve quality program outcomes. Requirements EDUCATION Bachelor’s Degree in Business or a Medical background. In lieu of degree, five (5) years' experience engaging with physicians and health care providers required in addition to the experience requirements listed below. EXPERIENCE & KNOWLEDGE Minimum five (5) years' experience engaging with physicians and health care providers. Minimum two (2) years' experience with government programs quality measure/program experience in Medicare (HEDIS, CMS Quality measures). Minimum two (2) years' experience related to regulatory requirements. Minimum two (2) years' leadership experience (role, project management, team leader, etc.) Experience working with Microsoft Office (Excel, Access, etc.). Experience working with healthcare claims data. Knowledge of Medicaid/Government Programs preferred. Knowledge of Arkansas clinical quality, physician, and pharmacy landscape preferred. Skills • Activity Coordination • Analyze Information • Coaching Others • Continuous Learning • Cross-Functional Communications • Decision Making • Employee Engagement Strategies • Evaluating Information • Interpersonal Communication • Interpersonal Relationships • Management Techniques • Monitor Processes, Materials, or Surroundings • Object Identification • Organizing • Public Relations (PR) Management • Service Oriented Responsibilities • Collaborates with other internal departments as necessary. • Collaborates with team to prepare reporting and documentation for updates to state Medicaid department and other team members. • Completes intervention outreach to members, as needed, for specified Medicaid measures or escalated cases from Clinical Outreach team. • Develops, implements, and manages performance improvement of Medicaid quality program while identifying and articulating results, barriers, and opportunities. • Drives the strategic direction and development of outreach programs at both the portfolio and initiative levels, ensuring compliance with Medicaid quality standards while improving outcomes across preventive screenings, medication management, behavioral health interventions, and appropriate clinical follow-up. • Manages budgets and staffing for interventions in collaboration. • Manages hiring, coaching, training, employee development, and performance management of team. • Partners with Healthcare Effectiveness Data and Information Set (HEDIS) Director and Education Manager to develop collaborative programs for clinical measure to educate providers and abstract medical records. • Performs other duties as assigned. • Provides clinical guidance, support and oversight to the assigned Medicaid teams. • Works with vendors and cross disciplinary teams to coordinate activities and oversees the collection, analysis, reporting and trending of data relative to Medicaid performance, outcomes and return on investment of intervention activities. Certifications Security Requirements This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual. Segregation of Duties Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual. Employment Type Regular ADA Requirements 1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment. Arkansas Blue Cross is consistently ranked as one of the best places to work in Central Arkansas. Why? We Love our Employees At Arkansas Blue Cross, we care about the health, wellness, and education of our employees. We offer many great incentives such as: Tuition reimbursement. Club Blue, a free, onsite gym to encourage exercise. Green Leaf Grill and Green Leaf Grill Express, onsite restaurants in Little Rock that promote healthy eating. Incentives for wellness education and exercise We Love our Culture The average tenure is 10 years with hundreds of employees having been here 15 years or longer. Our inclusive culture brings employees together to connect while celebrating our differences. We Love our Community Our employees often volunteer within their communities, at charity events, walks and runs, schools and nonprofits. When disasters strike, our employees help wherever they are needed. It’s just another way we show that Blue cares.

About the Company

Arkansas Blue Cross

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