NCQA Quality Manager (Hybrid)

CareFirst•Baltimore, MD

3d•Hybrid

About The Position

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.

Requirements

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.
5 years experience in healthcare, public health, health insurance, quality/process improvement or data management business environment.
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.
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.
Must be eligible to work in the U.S. without Sponsorship

Nice To Haves

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

Responsibilities

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.