Quality Programs Manager

Excellus BCBS•De Witt, AR

4d•$79,068 - $142,322

About The Position

Under the guidance of assigned management, the Quality Programs Manager manages complex programs and projects and provides higher-level operational and technical solutions that take a holistic, end-to-end approach to quality performance, including accreditation, regulatory compliance (CMS/DOH), member experience, and health plan performance. The role serves as a primary contact for internal and external stakeholders on program matters and provides leadership to ensure submissions meet specifications and deadlines, with ongoing monitoring of results. The position oversees program operations, planning, reporting, compliance, and performance measurement. It leads matrixed teams and coordinates with internal departments, vendors, auditors, regulators, and other stakeholders. The manager also develops program plans and dashboards, assesses risks and resources, manages scope and change, and provides education and coaching on quality improvement and accreditation requirements. The position promotes continuous improvement, operational efficiency, and a culture of excellence while maintaining confidentiality and member privacy.

Requirements

Bachelor’s degree in Nursing, Business or Healthcare Administration, Analytics, Project Management, or a related field, and at least 5 years of related work experience; alternatively, at least 11 years of related work experience in lieu of a degree.
At least 3 years of project management experience.
Applied knowledge of quality improvement, accreditation, and regulatory compliance.
Demonstrated leadership skills and knowledge of quality principles, problem solving, and quality tools and techniques.
Ability to form and foster high-performance cross-functional teams.
Strong verbal and written communication skills, including communication with internal and external audiences across disciplines and management levels.
Strong coaching and facilitation skills to drive improvement, matrix ownership, and change.
Strong vendor management skills.
Very strong analytical and business process development skills.
Demonstrated success working in a fast-paced environment.
Competence in staff leadership and project leadership tasks.
In-depth knowledge of application delivery, management structures, and reporting procedures.
Experience integrating enterprise applications.
Experience managing teams working under multi-phase and multi-deployment project schedules.
Experience communicating with senior management through discussions, written reports, meetings, and executive presentations.
Knowledge and experience in healthcare, health insurance, or a similar industry.
Ability to work while sitting or standing at a workstation, viewing a computer and using a keyboard, mouse, and/or phone for three or more hours at a time.
Ability to work in a home office for continuous periods for business continuity.
Ability to travel across health plan service regions as needed.
Ability to lift, carry, push, or pull 15 pounds or less.
Manual dexterity, including fine finger motion.
Ability to hear, understand, and speak clearly while using a phone, with or without a headset.

Nice To Haves

Master’s degree.
PMI/PMP certification.
Knowledge of basic statistical concepts and survey design skills.
Current and thorough understanding of federal and state regulations for all lines of business, including NCQA, CMS, IHI, AHRQ, NQF, and NYSDOH reporting requirements.

Responsibilities

Manage complex programs and multiple related projects, emphasizing outcomes, operational optimization, and organizational priorities.
Manage day-to-day operations to assess compliance with program standards.
Communicate with stakeholders at all levels to review scope and progress, resolve barriers, and support timely program completion.
Plan, schedule, monitor, and report program activities, including creating and presenting trending reports to executive management.
Develop program plans, provide leadership, and monitor progress and deadlines.
Oversee high-visibility projects independently, including scope management, problem identification, solution development and implementation, and outcome evaluation.
Troubleshoot program issues, use available resources to find answers, and escalate issues when needed.
Develop and maintain progress reports and dashboards with Quality Measurement to assess intervention impact, compliance, and program status.
Participate in committees and work groups; represent the program and prepare and present reports and materials, including for Quality Committees.
Serve as a program and quality subject matter expert, promoting awareness of the program and its relationship to quality ratings and corporate goals.
Build collaborative relationships with project managers and divisional and cross-functional leads.
Serve as the primary contact for internal and external inquiries and manage vendor, auditor, and regulator relationships, including calls, site visits, audits, consultants, and staff preparation.
Coordinate collection and submission of required evidence and assess program compliance.
Oversee the development, contracting, implementation, and compliance monitoring of delegation and vendor agreements.
Provide governance and oversight for program team rooms, artifacts, and schedules.
Organize and facilitate program reviews and meetings with team members and cross-functional stakeholders, ensuring coordinated and consistent approaches.
Plan, direct, and coordinate matrixed teams implementing interrelated projects from contract or proposal initiation through operational completion.
Determine and monitor program costs, budgets, staffing, resources, and risks.
Develop contingency plans for schedule changes, staffing adjustments, funding allocations, and work requirements.
Control program requirements, scope, and change management; facilitate communication about critical-path issues, risks, and mitigation.
Select appropriate planning tools, estimate work, produce work plans, and collaborate on short- and long-term plans.
Establish metrics for key program criteria and monitor performance against them.
Conduct competitive intelligence and research best practices, evaluate potential implementation, and maintain knowledge of emerging technologies, project management methods, and regulatory and accreditation requirements.
Attend relevant training and conferences, provide staff training and guidance, and implement new requirements across affected regions.
Educate, assist, and coach staff involved in quality improvement and accreditation using current methods for measurement, analysis, and performance tracking; train and mentor stakeholders on requirements.
Coach cross-functional teams to complete activities, meet schedules, and resolve technical or operational issues.
Monitor and evaluate the quality of work and deliverables within the role’s scope.
Promote continuous improvement, efficiency, productivity, waste reduction, and cost reduction.
Advance a culture of excellence rooted in customer experience guiding principles.
Protect confidential information in accordance with New York State Education Law, Public Health Law, and corporate privacy policies and procedures.
Demonstrate integrity, support the Lifetime Healthcare Companies’ mission and values, and adhere to the Corporate Code of Conduct and Lifetime Way values.
Maintain regular and reliable attendance and perform other functions as assigned by management.