BlueCross BlueShield of South Carolina
Location
Columbia, SC | United States
Job description
Summary
BlueChoice Health Plan is a wholly owned subsidiary of BlueCross BlueShield of South Carolina, the largest health insurance company in the Palmetto State. We offer and excellent working environment, with quality benefits.
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Description Position Purpose: As the
Director of Quality – Medicaid , I will provide strategic leadership for BlueChoice’s Medicaid Quality Program in alignment with organizational and state quality and population health goals and ensure compliance with all contractual, state, and federal requirements. The ideal candidate for this role will also be responsible for management and oversight of a quality infrastructure that promotes quality of care and improves health disparities, and someone who is culturally competent and facilitates cost-effective care in the safest, least restrictive setting while partnering with matrixed leaders to ensure NCQA accreditation, EQRO, and HEDIS requirements are met.
Logistics This is a full-time position working (40 hours/week) Monday-Friday 8:00am – 5:00pm working
on-site at
4101 Percival Rd. Columbia SC, with the ability to work a hybrid schedule 1-2 days per week. This role includes 10-15% travel to provider offices or state meetings.
What You’ll Do - Accountable for achievement and oversight of quality initiatives that meet contractual requirements.
- Develop and manage portfolio of quality improvement initiatives including PIPs and other population health programs aligned with SCDHHS quality priorities.
- Reinforce the application of quality improvement methodologies and tools across health plan quality initiatives and projects.
- In partnership with matrixed leaders ensure NCQA readiness, accreditation, and ongoing compliance with NCQA requirements.
- Support the development and implementation of programs and processes to achieve HEDIS and state-based value-based reimbursement program requirements.
- Develop relationships with providers in value-based arrangements.
- Serve as primary driver of performance improvement for the health plan, including committee oversight, work plans and annual evaluation.
- Establish and implement governance and oversight of the health plan quality program, including coordination of committee structure.
- Provide effective leadership and management of direct reports and members of the quality team to build a high performing team.
- Oversees health plan improvement teams and coordinate QI training for health plan.
- Serve as primary liaison with state and represent the health plan externally on state quality work groups and committees.
To Qualify For This Position, You’ll Need - Required Education: Bachelor's degree
- Degree Equivalency: 4 years of job-related work experience or Associate’s degree with 2 years of job-related experience
- Required Specialized Training: Current unrestricted South Carolina registered nurse, physician, or physician’s assistant, or be certified as a Certified Professional in Health Care Quality (CPHQ) by the national Association of Healthcare Quality (NAHQ) and/or certified in Health Care Quality and management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers prior to employment or within 6 months of the hire date.
- Required Work Experience: 10 years of job-related experience in a health plan, healthcare provider or other healthcare organization including either 5 years in a management role OR 5 years of equivalent military.
- Strong interpersonal skills and the ability to work professionally with persons at all levels to maintain effective working relationships.
- Ability to communicate clearly and effectively in oral and written form.
- Strong presentation, negotiation, and organization skills.
- Excellent analytical or critical thinking and problem-solving capabilities.
- Ability to make sound decisions.
- Ability to exercise confidentiality and discretion.
- Strong knowledge of relevant compliance regulations associated with operations and contract responsibilities.
- Knowledge of quality improvement tools and methodologies.
- Microsoft Office
What We Can Do For You We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
- Subsidized health plans, dental and vision coverage
- 401K retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- On-site cafeterias and fitness centers in major locations
- Wellness program and healthy lifestyle premium discount
- Tuition assistance
- Service recognition
- Employee Assistance
- Discounts to movies, theaters, zoos, theme parks and more
What To Expect Next After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications required proof of semester hours, please attach your transcript to your application.
Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Here's more information.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail
[email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
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