Offer summary

Qualifications:

Bachelor's degree or advanced degree in a related field, or 5+ years of relevant experience in lieu of a degree., 3+ years of experience in program management or related field., Knowledge of DSNP clinical quality improvement operations and HEDIS is essential., Strong analytical, organizational, and problem-solving skills are required. .

Key responsibilities:

Manage and administer smaller programs or phases of larger programs to meet objectives.

Monitor program progress and document results through reports and presentations.

Recommend and implement program changes to achieve goals and manage budget responsibilities.

Collaborate across departments and support compliance-related functions and annual HEDIS activities.

Job description

Job Description

Manage small programs or a phase of a larger program. Provide full program management including needs analysis, program maintenance, administration and monitoring, data analysis, program evaluation, and vendor/contract administration if applicable. May also make recommendations for changes or modifications for assigned program and implement as needed.

What You'll Do

Manage/administer smaller programs or a phase of a larger program to ensure that prescribed activities are carried out in accordance with program objectives.
Assess needs and coordinate resources to enhance existing programs.
Monitor the progress of program components to ensure the overall goals, schedules, and benefits of the program will be met.
Document and present program results through operational reports, outcomes studies, presentations and publications. Prepare program reports for superiors.
Recommend and/or implement program and process changes as needed to achieve program goals and objectives.
May have budget responsibilities to control expenditures in accordance with budget allocations, together with the conformance to timing, limits and usage of funding as agreed upon in the spending plan for the assigned program.
May handle vendor management and administer program contracts to ensure vendors meet service level agreements if applicable.
Review reports and records of activities to ensure progress is being accomplished toward specified program objective and modify or change methodology as required to redirect activities and attain objectives.
Developing HEDIS project plans.
Cross-departmental collaboration and stakeholder education.
Responsible for DSNP HEDIS program management which includes HEDIS Roadmap, production runs, admin refresh, reporting, etc.
Perform compliance related functions including, but not limited to: CCIP, program descriptions, HPMS memos, QIC coordination and facilitation, policy coordination.
Support annual HEDIS functions such as: rate review, HEDIS roadmap, Medical Record Review (including overreading), analyze rates and trends, etc.
Other ad hoc duties as assigned.

What You'll Bring

Bachelor's degree or advanced degree (where required)
3+ years of experience in related field
In lieu of degree, 5+ years of experience in related field
Knowledge of DSNP clinical quality improvement operations and HEDIS

Bonus Points

Strong analytical, organization, and problem-solving skills
Strong written and verbal communication skills and ability to successfully interact with all levels of management
Knowledge of Blue Cross NC or prior healthcare payer experience strongly preferred

What You’ll Get

The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community

Work-life balance, flexibility, and the autonomy to do great work

Medical, dental, and vision coverage along with numerous health and wellness programs

Parental leave and support plus adoption and surrogacy assistance

Career development programs and tuition reimbursement for continued education

401k match including an annual company contribution

Learn more

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

*Based on annual corporate goal achievement and individual performance.

$68,200.00 - $109,100.00

Skills

Budgeting, HEDIS, Office Administration, Process Improvements, Program Administration, Program Documentation, Program Evaluations, Program Implementation, Program Management, Project Management, Resource Allocation

Required profile