Director of Quality Management

Job Summary

The Director of Quality Management is responsible for directing the activities of the quality management and regulatory management functions within the division. This position coordinates resources within the division and the corporation to provide quality management and related services regarding service providers to assure quality and consistency for members, providers and the company. In addition, this position oversees regulatory certification for the appropriate programs, departments and/or functions on behalf of the company. The Director of Quality Management leads all quality improvement design, development and ongoing improvements and maintenance with an integrated approach to quality improvement. This position assesses opportunities for improvement and implements changes that will have a positive impact on outcomes and compliance with the plan's policies and contractual obligations.

 

Essential Functions

• Provides leadership and guidance for all the quality management functions within the division. Selects, trains, and manages staff engaged in credentialing and certification of providers and in related quality assurance activities.
• Establishes internal processes and work methods to assure work is carried out on an efficient and timely basis with appropriate attention to quality and thoroughness.
• Oversees monitoring, measuring and reporting activities and collaborates with staff and others to evaluate findings and improve processes and outcomes.
• Participates on various committees as the quality and regulatory leader to develop, maintain, or revise current processes, practices, reporting, etc. to ascertain standards compliance.
• Oversees regulatory and compliance activities for division and corporation.
• Leads the accreditation survey process along with certification maintenance and management for both the commercial and exchange books of business in order to maintain the proper status.
• Acts as the subject matter expert and key contact source for all Healthcare Effectiveness Data and Information Set (HEDIS) related quality standards: Stars, Accreditation, Federal Employee Program (FEP), Medicare, Dual Eligible Special Needs Plan (D-SNP), and Medicaid.
• Closely monitors and ensures necessary steps are taken to achieve a successful year over year improvement of Stars/HEDIS measures and achievement of National Committee for Quality Assurance (NCQA) HEDIS accreditation targets for all lines of business.
• Develops strategic plans, policies and results reporting for improved quality throughout the plan and works with senior management on communication of information.

 

Knowledge, Skills and Abilities

Staff Leadership

Advanced

Attention to Detail and Accuracy

Intermediate

Coaching

Intermediate

Collaboration

Intermediate

Prioritization and Organization of Work

Advanced

Problem Solving and Resolution

Advanced

 

Education Requirements

Required: Bachelor's

Preferred: Bachelor's

Field(s) of Study: Healthcare, Business or related field

 

Experience Requirements

Required: Minimum of 7 Years

Preferred: Minimum of 7 Years

Experience Details: Minimum of 7 years of healthcare experience in quality and regulatory management or related experience is required, of which 5 years of supervisory/staff leadership experience is required; nursing experience is preferred.

 

Certification, Licensures & Registration Requirements

Title: N/A

State or Agency: N/A

 

Equivalent combination of education, experience or training determined to be acceptable by Human Resources may be substituted, unless regulated by contract or program standards

 

Physical Demands

Walking

Occasional (30-60%)

Sitting

Frequent (60-90%)

Use of Computer

Frequent (60-90%)

Talking

Frequent (60-90%)

Other Information

Important Notice: BCBSND has a vaccination protocol in place that requires any employees who physically work in a BCBSND office or whose role requires direct customer contact to be vaccinated against COVID-19. We respect your choice to get vaccinated (or not) and getting vaccinated is not a condition of employment. If you are not vaccinated, you may work remotely if your role allows for it. If your role does not allow for remote work and you are unable to get the COVID-19 vaccine, there is an exception process available that includes a weekly testing regimen.

 

Job Posting Policy

Employees new to Blue Cross Blue Shield of North Dakota are eligible to apply for positions within their assigned department after successfully completing 90-days in their role. For positions outside of their department, new employees should attain a minimum of six months of service before applying for a new role. Exceptions to this are acceptable, provided there is good business justification for making the move.

 

Equal Opportunity Employment

Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individual with Disabilities, as well as Sexual Orientation or Gender Identity.

For questions, please email careers@bcbsnd.com

This job posting will be closed 10/29/2021 at 8:00AM CST. No further applications will be considered.