NCQA Quality Manager (Hybrid)

Resp & Qualifications

We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.

PURPOSE:

The NCQA Quality Manager oversees the NCQA Health Plan and Health Outcomes accreditation process from end to end for all LOBs. They will project manage the efforts and deliverables, supervise staff and assist in the development and creation of analyses, policies, and workplans to support the NCQA standards. The Manager will lead a team of associates responsible ensuring compliance with national quality standards. 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.

ESSENTIAL FUNCTIONS:

• 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.

SUPERVISORY RESPONSIBILITY:

This position manages people.

QUALIFICATIONS:

Education Level: Bachelor''s Degree in population health, public health, healthcare administration, business administration, health policy, economics, statistics, mathematics, data science, or a related field OR in lieu of a Bachelor''s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 5 years experience in 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 healthcare data. 1 year supervisory experience or demonstrated progressive leadership experience

Preferred Qualifications:

• Training or certification in Quality or Process Improvement Methods
• Must have NCQA HP and HO experience., audit preparation and policy expertise.

Knowledge, Skills and Abilities (KSAs)

• Ability to perform qualitative and quantitative data analyses and create innovative strategies and work with colleagues to address findings.
• Ability to learn the technical aspects of collection and reporting of both administrative and clinical aspects of quality measures.
• Ability to conduct advanced analytics using SQL, Python, R, or similar; fluent in Excel. Expertise with healthcare claims, survey, clinical, and health data.
• Strong computer skills to include Microsoft Office - Excel, Word, Power Point, Outlook.
• 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.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $108,000 - $200,475

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate''s work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case''s facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

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.

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.

PHYSICAL DEMANDS:

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

#LI-NH2