Senior Manager Clinical Oversight and Special Proj
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Chicago, IL 60601
This position is responsible for the overall management including directing a team of clinical and non-clinical staff in quality management and quality improvement activities for HEDIS, QRS reporting, NCQA accreditation and regulatory compliance and submissions. Ensures successful HMO and PPO NCQA HEDIS and QRS Measure Set data collection, medical record audits and timely submission of data including interpretation of results for reporting to executive leadership. Responsible for maintaining NCQA accreditation efforts by directing and managing team responsible for NCQA Quality standards oversight. Participates in the development and coordination of special pay-for-performance initiatives. Serves as lead and liaison to HCSC’s Marketing and other divisions to develop and deliver reports, performance guarantees and RFP/RFI support. Additionally, is the primary point of contact for all HEDIS and QRS internal and external inquiries.
Required Job Qualifications:
- Bachelor’s degree in health care or business field.
- Registered Nurse (RN) or Clinician with unrestricted license in state of operations and three years clinical experience.
- 5 years’ experience performing and managing medical record audits in a health care environment including chart abstractions and reporting
- 2 years management experience including hiring and training staff, leading, and mentoring direct reports.
- Experience with and thorough knowledge of HEDIS measures and QRS operations, reporting and NCQA/URAC accreditation regulatory compliance guidelines.
- Verbal and written communication skills, including the ability to interact successfully with a variety of staff across multiple divisions and building relationships.
- Project management and organizational skills, including the ability to prioritize tasks, request assistance as appropriate, and accept direction and feedback. Flexibility and responsiveness in managing multiple projects concurrently.
- Knowledge of insurance administration and health care products.
- Leadership skills including the ability to lead and mentor staff.
- Creativity and innovative skills and a willingness to take risks.
- PC experience utilizing various software packages including Excel, Access, and Word.
Preferred Job Qualifications:
- Master’s degree.
- Presentation and group facilitation experience.
- 2 years’ experience with NCQA Accreditation and/or HEDIS.
- 3 years data analysis experience.
- Knowledge of quantitative and qualitative standards and measures and statistical measures and concepts
HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.
BCBSTX complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.