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Associate Director, Quality Operations
Recruited by BAXTER 9 months ago Address , Marion $128,000 - $252,000 a year

Director, Operations Oversight And Quality

Company

BlueCross BlueShield of South Carolina
Address , Columbia, Sc
Employment type FULL_TIME
Salary
Expires 2023-10-07
Posted at 9 months ago
Job Description
Summary
Responsible for comprehensive compliance/oversight program designed to meet all business/contract requirements. Responsible for operational oversight to ensure membership, quality, and financial goals are met. Directs multiple operational areas that may consist of contracts, training, investigation, quality assurance, control, improvement etc. to ensure full compliance of processes, procedures, and/or guidelines related to the operations. Operates as the primary liaison for business contract(s) and is responsible for associated auditing/reporting requirements/activities as well as results.

Description
  • Develops strategies and establishes operation policies consistent with contract requirements. Evaluates the results of overall operations regularly, lead development and implementation of needed operational efficiencies. Identify and develop programs to increase membership growth and profitability. Responsible for oversight of subcontractors’ quality. Oversee government audits and regular government on sites. Develop, direct, and maintain contractor and state regulatory relationships. Responsible for financial and quality goals.
  • Lead interdepartmental team comprised of Sr. Leadership to develop strategies and identify corporate resources to leverage. Identify and partner with appropriate internal and community organizations to strengthen brand, create market awareness and increase membership.
  • Mentor and coach staff to ensure implementation of product strategies and efficient plan operations. Responsible for employee hiring, training and development, addressing performance issues, resource planning and strategic objectives. Promote professional growth. Provide guidance and leadership in staff and resource management, team building and training to ensure organizational effectiveness.
  • Oversees the development and implementation of new product benefits and their execution. Develops and oversees an oversight program that meets the requirements as outlined by the contract (s).
  • Creates/Coordinates/submits responses to applicable business or government entities. Reviews all memos/transmittals to ascertain appropriate action required and subsequently communicates required action. Monitors resolution activities, creates responses to applicable business or government entities.
Required Education: Bachelor's degree in Business, Healthcare, Accounting, Finance, or other job-related field
Required Work Experience: 10+ years-of job related operations oversight experience (including marketing, medical management, provider relations, quality, program integrity, compliance, claims, customer service, behavioral health, and/or finance) in an insurance, healthcare, or similarly complex industry including either 5 years in a management role OR 5 years of equivalent military experience in grade E4 or above.
Required Skills and Abilities: 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 think strategically and lead operational improvements. Ability to make sound decisions. Ability to exercise confidentiality and discretion. Strong knowledge of relevant compliance regulations associated with operations and contract responsibilities.
Required Software and Other Tools: Microsoft Office
Preferred Education: Master's degree in Business, Healthcare, Accounting, Finance, or other job-related field
Preferred Work Experience: 10+ years-of audit/compliance experience working with business and/or government contracts. 3 years quality programs oversight; experience with various accreditation entities, URAC, NCQA; experience with measurement and improvement in quality metrics, HEDIS, STARS. Experience with program and/or product management. Experience working in a matrix-management environment.
Preferred Skills and Abilities: Knowledge of current trends and industry best practices.
Work Environment: Typical office environment. Some out of town travel. Some travel between office buildings.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.