Manager, Medicare Advantage Risk Adjustment and Health Services

BlueCross BlueShield of South Carolina•Columbia, SC

86d•Onsite

About The Position

Summary Oversees direct coaching support to a physician/provider practices to make improvements in systems and delivery of care. Ensures establishment and maintenance of excellent relationships with network hospitals, physician and/or designated practices, and their representatives. Leads activities related to outreach and coaching support to designated practices. Leads project quality measurement, reporting, and communications activities. Plans detailed special projects and leads Quality Improvement (QI) project planning teams and workgroups. Provides direct QI coaching to practices as needed, and/or will work in partnership with any existing practice or health system QI coaches (where they exist) to build QI capacity within practices to meet improvement goals. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Description Logistics: BlueCross BlueShield of South Carolina - About Us | BlueCross BlueShield of South Carolina Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 17 Technology Circle Columbia, SC, 29203. What You’ll Do: Ensures establishment and maintenance of excellent relationships with provider organizations. Leads activities related to outreach and serves as liaison to provider organizations and physician practices for assigned programs. Assures compliance with established quality program standards. Coaches practices in the collection and management of relevant program data. Analyzes trends regarding practice performance to inform coaching plans and opportunities for shared learning events. Prepares and submits various reports to management. Works with other relevant provider organizations and statewide groups, as applicable, to coordinate and align quality improvement efforts. Plans detailed special projects and leads project planning teams and workgroups using various continuous QI tools and methodologies. Recommends courses of action to management in the development and completion of special projects requiring quality and process improvement skills. Supports integration with other related initiatives. Identifies and facilitates opportunities to integrate projects with other QI initiatives. Develops and disseminates relevant project materials, communications, surveys, etc. Provides direct practice facilitation and QI coaching to practice teams, ongoing training, consultation and monitoring to facilitate practice redesign and/or other QI improvements for designated practices. Provides support to existing practice coaches where those exist with ultimate goal of developing QI capacity of practice team to make improvements in practice operations and/or clinical quality. Develops relationships and works with consumer organizations as appropriate. Identifies and shares best practices through webinars, website and/or QI learning sessions. Stays abreast of new developments and industry trends related to best practices in clinical QI and practice transformation. Creates educational materials (webinars, brochures, etc.) for providers and conducts provider training as needed. Makes presentations to individuals and groups as indicated. Ensures appropriate communication with key stakeholders. Works with health program staff to create and update web-based communications and information. Contributes to health programs and project communications as appropriate. To Qualify for This Position, You’ll Need the Following: Required Education: Bachelor's Degree equivalency: Four years of job-related work experience or associate's and two years job related work experience. Required Work Experience: 6 years of healthcare system management, quality improvement, provider network, health claims management or a combination of these. 2 years’ experience with direct health programs. 2 years project coordination experience. Leadership experience. (all may be concurrent). Required Skills and Abilities: Knowledge/understanding of automated medical management systems and claims processing systems. Experience in health care office environment with demonstrated responsibility for process improvement and quality improvement. Knowledge of quality improvement concepts, and ability to learn models and methods including clinical practice transformation models and methods. Excellent verbal communication and presentation skills. Ability to demonstrate excellent writing and written communication skills. Excellent relationship management skills. Ability to work independently and to collaborate with teams of individuals in diverse settings, with solution-oriented approach. Good judgment. Strong leadership skills. Demonstrated customer service and organizational skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Working knowledge of project management tools. Required Software and Tools: Microsoft Office. Must have qualification as certified risk coder (CRC) Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information. If you don’t have an account with us and don’t see the dream job you are looking for, click on the link above to Join Our Talent Community by submitting your resume and contact information and we will reach out if we find a good fit. Welcome Here’s Your Smart Career Move Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Veterans Welcome! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. Join Us If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!

Requirements

Bachelor's Degree equivalency: Four years of job-related work experience or associate's and two years job related work experience.
6 years of healthcare system management, quality improvement, provider network, health claims management or a combination of these.
2 years’ experience with direct health programs.
2 years project coordination experience.
Leadership experience. (all may be concurrent).
Knowledge/understanding of automated medical management systems and claims processing systems.
Experience in health care office environment with demonstrated responsibility for process improvement and quality improvement.
Knowledge of quality improvement concepts, and ability to learn models and methods including clinical practice transformation models and methods.
Excellent verbal communication and presentation skills.
Ability to demonstrate excellent writing and written communication skills.
Excellent relationship management skills.
Ability to work independently and to collaborate with teams of individuals in diverse settings, with solution-oriented approach.
Good judgment.
Strong leadership skills.
Demonstrated customer service and organizational skills.
Ability to persuade, negotiate, or influence others.
Analytical or critical thinking skills.
Ability to handle confidential or sensitive information with discretion.
Working knowledge of project management tools.
Microsoft Office.
Must have qualification as certified risk coder (CRC)

Responsibilities

Ensures establishment and maintenance of excellent relationships with provider organizations.
Leads activities related to outreach and serves as liaison to provider organizations and physician practices for assigned programs.
Assures compliance with established quality program standards.
Coaches practices in the collection and management of relevant program data.
Analyzes trends regarding practice performance to inform coaching plans and opportunities for shared learning events.
Prepares and submits various reports to management.
Works with other relevant provider organizations and statewide groups, as applicable, to coordinate and align quality improvement efforts.
Plans detailed special projects and leads project planning teams and workgroups using various continuous QI tools and methodologies.
Recommends courses of action to management in the development and completion of special projects requiring quality and process improvement skills.
Supports integration with other related initiatives.
Identifies and facilitates opportunities to integrate projects with other QI initiatives.
Develops and disseminates relevant project materials, communications, surveys, etc.
Provides direct practice facilitation and QI coaching to practice teams, ongoing training, consultation and monitoring to facilitate practice redesign and/or other QI improvements for designated practices.
Provides support to existing practice coaches where those exist with ultimate goal of developing QI capacity of practice team to make improvements in practice operations and/or clinical quality.
Develops relationships and works with consumer organizations as appropriate.
Identifies and shares best practices through webinars, website and/or QI learning sessions.
Stays abreast of new developments and industry trends related to best practices in clinical QI and practice transformation.
Creates educational materials (webinars, brochures, etc.) for providers and conducts provider training as needed.
Makes presentations to individuals and groups as indicated.
Ensures appropriate communication with key stakeholders.
Works with health program staff to create and update web-based communications and information.
Contributes to health programs and project communications as appropriate.