Quality Programs Manager

Excellus BCBS•Rochester, NY

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, member experience, and health plan performance. The role is an integral part of the team and serves as the primary contact for internal and external stakeholders on program matters. It provides leadership and direction to ensure program submissions meet specifications and deadlines, and that results are monitored on an ongoing basis. The manager leads program planning and execution, monitors progress and outcomes, oversees compliance with program standards, and coordinates cross-functional teams and stakeholders. The role develops progress reports and dashboards, presents program status and trends to executive management and committees, manages vendor and auditor relationships, coordinates evidence collection and submissions, and oversees related agreements and governance. It also provides training, guidance, education, and coaching on quality improvement and accreditation activities, while promoting continuous improvement, efficiency, and alignment with organizational goals. The position requires a bachelor's degree in a relevant field and at least five years of related work experience, including at least three years of project management experience, or 11 years of related experience in lieu of a degree. A master's degree and PMI/PMP certification are preferred. The position includes work in a typical office environment, the ability to work in a home office for business continuity, and travel across health plan service regions as needed.

Requirements

Bachelor's degree in Nursing, Business or Healthcare Administration, Analytics, Project Management, or a related field, plus at least five years of related work experience; alternatively, at least 11 years of related work experience in lieu of a degree.
At least three years of project management experience.
Applied knowledge of quality improvement, accreditation, and regulatory compliance.
Demonstrated leadership skills, knowledge of quality principles, and proficiency in problem solving and quality tools and techniques.
Demonstrated ability to form and foster high-performance cross-functional teams.
Strong verbal and written communication skills, including effective communication internally and externally and across the organization.
Strong coaching and facilitation skills to drive improvement, matrix ownership, and change.
Strong vendor management skills and very strong analytical and business process development skills.
Demonstrated success working in a fast-paced environment.
Demonstrated competence in staff leadership and project leadership tasks.
In-depth knowledge of application delivery, management structures, and reporting procedures.
Demonstrated experience integrating enterprise applications.
Demonstrated experience managing teams executing multi-phased and multi-deployment project schedules.
Demonstrated experience communicating with senior management through informal discussions, written reports, scheduled meetings, and executive-level presentations.
Knowledge and experience in healthcare, health insurance, or a similar industry.
Knowledge of federal, state, and accreditation standards, including NCQA, CMS, IHI, AHRQ, NQF, and NYSDOH reporting requirements.
Ability to sit and/or stand at a workstation while 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 preferred.
PMI/PMP certification preferred.
Knowledge of basic statistical concepts and survey design skills preferred.
Maintains a current and thorough understanding of federal and state regulations for all lines of business as they relate to job responsibilities preferred.

Responsibilities

Manage complex programs and multiple projects, maintaining an enterprise-wide perspective and focusing on measures, outcomes, operational optimization, and changing business priorities.
Manage day-to-day operations and assess organizational compliance with program standards.
Communicate program scope, progress, issues, and barriers to users, customers, colleagues, sponsors, project teams, and management; resolve issues as needed to support timely completion.
Plan, schedule, monitor, and report program activities; develop program plans and monitor progress and deadlines.
Create and present formal trending reports to keep executive management apprised of program status and completion.
Independently oversee and assess high-visibility projects, including scope management, issue identification, solution development and implementation, and evaluation of outcomes.
Troubleshoot issues, identify necessary resources, and escalate matters when appropriate.
Collaborate with Quality Measurement to develop and maintain progress reports and dashboards that track intervention impact, goals, compliance evidence, and program status.
Participate in committees and work groups; represent the program; and prepare reports, data, and presentations, including for Quality Committees.
Serve as a program and quality subject matter expert and ambassador, promoting awareness of the program's relationship to quality ratings and corporate goals.
Build collaborative relationships with project managers, divisional leads, and cross-functional partners throughout the organization.
Serve as the primary contact for internal and external program inquiries.
Manage vendor, auditor, and regulator relationships, including calls, site visits, audits, consultants, and staff preparation.
Coordinate collection and submission of evidence required for program requirements and assess compliance.
Oversee development, contracting, implementation, and compliance of program-related delegation and vendor agreements; define agreement content, oversight activities, and reporting with business areas and monitor ongoing compliance.
Provide governance and oversight for program team rooms, artifacts, and schedules; organize and facilitate regular program reviews and meetings with team members and cross-functional stakeholders.
Plan, direct, and coordinate matrixed teams and interrelated projects from contract or proposal initiation through final operational stages.
Determine, monitor, and review program costs, budgets, staffing, resources, and risks; formulate contingency plans for schedule, staffing, funding, and work requirement changes.
Control program requirements, scope, and change management; facilitate management communications on critical-path issues, risks, and mitigation approaches.
Select appropriate tools to estimate and plan team work, produce work plans to required standards, and collaborate on short- and long-term plans.
Establish metrics for key program criteria and monitor results against those metrics.
Conduct competitive intelligence and research best practices with internal departments, evaluating potential implementation.
Maintain knowledge of emerging technologies, project management techniques, and applicable regulatory and accreditation requirements; attend relevant classes, training, and conferences.
Provide training and guidance to staff and implement plans for incorporating new requirements across impacted corporate regions.
Educate, assist, and coach staff involved in quality improvement and accreditation activities using current improvement methods, 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 performance and work products within the position's scope.
Foster continuous improvement, seek ways to increase efficiency and productivity, reduce waste and costs, and advance a culture of excellence rooted in CX guiding principles.
Protect confidential information in accordance with New York State Education Law, Public Health Law, and corporate privacy policies and procedures.
Demonstrate integrity by supporting the Lifetime Healthcare Companies' mission and values, following the Corporate Code of Conduct, and leading according to Lifetime Way values and beliefs.
Maintain regular and reliable attendance and perform other functions assigned by management.