Director, Program Improvement

BlueCross BlueShield of South Carolina•Florence, SC

22h•Onsite

About The Position

Responsible for directing all aspects of the change management process. This position is directly responsible for staff whose work effort includes project management of contract change order implementation and the gathering and approving of data from IS and Operations for proposal submission and negotiation of change orders. Responsible for directing the implementation, maintenance and oversight of a Quality Management System/Program that meets contractual requirements, including accreditation, and drives continuous operational efficiencies and quality improvements. Responsible for directing, overseeing, and documenting the Training and Quality Assurance audit functions to meet contractual and customer requirements. Responsible for reporting and analytics to support operational workloads, customer requirements, and continuous improvement. This positions also provides leadership to quality management initiatives within the organization. This position is also responsible for the following Palmetto GBA functions/programs: Change Management Office ISO Certification & Audit Coordination Quality Management System Training Quality Assurance and contract specific Quality Control Plans Oversight and coordination of the leadership development programs including Mid-Level Leader, new manager workshops, and tenured leader workshops. Oversight and coordination of Pathstream programs Coordinate and participate in government audits Coordinate bi-annual Employee Engagement Survey Lean Six Sigma projects and program coordination

Requirements

Bachelors in a job-related field
10 years of job-related experience including either 5 years of management experience OR 5 years of equivalent military experience in grade E4 or above.

Nice To Haves

5+ years call center management experience
experience using Avaya
Provider/Member outreach and education experience
Medicare Operations experience

Responsibilities

Direct and actively participate ensure change management activities are properly estimated and implemented in a timely, accurate fashion and in accordance with all government and customer requirements.
Work with all areas of the organization to ensure change management tasks and projects are complete, provide reporting and recommendations for improvement to senior leadership.
Implement, maintain and oversee a Quality Management System / Program that meets contractual requirements.
Perform audits of units, review policies and procedures, and investigation of complaints to determine compliance.
Responsible for quality improvement oversight, including accreditation and various quality initiatives.
Direct the internal training function, assessing training needs.
Provide action plans, deliver internal and external solutions and evaluate results.
Create high caliber materials for in-class room and web-based training curriculum.
Ensure contractual requirements are met.
Direct the Quality Assurance internal audit function.
Develop and maintain audit processes.
Design focus audit requirements as needed.
Provide evidence of successful employee knowledge of systems, processes, and products.
Ensure accurate and available data for external audits.
Direct a reporting and analytics team to support operational workload reporting, customer requirements, and continuous improvement.
Establish, communicate, motivate and achieve individual staff and departmental goals; facilitate training opportunities, develop and provide feedback.
Ensure effective continuous collaboration between QMS, training, QA and operations that focuses on operational performance and outcomes accountability.