Quality Programs Manager at Excellus BCBS, Rochester

Quality Programs Manager at Excellus BCBS in Rochester. Full-time. $79,068 to $142,322 a year. Apply with swipeandhired.

Under the guidance of assigned management, this position manages related complex programs/projects as well as provides higher level operational and technical solutioning that reflects a more holistic or end-to-end approach to quality performance, i.e. accreditation, regulatory (CMS/DOH), member experience and health plan performance.

This position is an integral part of the team serving as the primary contact to internal and external stakeholders in all matters related to program. The Program Manager provides leadership and direction to ensure the program submissions are delivered according to specifications and deadlines along with ongoing monitoring of results.

Essential Accountabilities:

• Performs elevated program management duties; specifically, provides focus on measures/outcomes and operational optimization/efficiencies, manages multiple projects, manages change in business strategies and priorities and maintains an organizational / enterprise lens to all activities.
• Manages day-to-day operations to assess the organizations compliance with program standards.
• Communicates effectively with users/customers, colleagues, sponsors, project teams and across a range of disciplines, and all levels of management to review project scope/progress and resolve program issues/barriers, as often as necessary to ensure timely completion of the program.
• Plans, schedules, monitors, and reports on activities related to the program.
• Creates and makes formal presentations of trending reports throughout program cycle to keep executive management apprised of current status and completion.
• Provides leadership to develop program plan, monitors progress and timeliness to ensure deadlines are met.
• Acts independently to oversee, assess and monitor high visibility projects/activities to drive program including but not limited to managing scope, problem identification, developing potential solutions, implementing them and evaluating outcomes involving various staff as needed.
• Responsible for troubleshooting and using all resources to find needed answers. This includes assessing when to elevate issues and doing so as needed
• In collaboration with Quality Measurement, develops, maintains progress reports (dashboards) to determine impact of interventions relative to goals, evidence compliance and status of program.
• Participates in relevant committees and work groups; represents program, makes advanced presentations, prepares reports, data or other materials for committee presentation including but not limited to Quality Committee’s.
• Act as an ambassador/subject matter expert for program and quality as well as socialize organizational importance and awareness for the program including how program relates to quality rating programs and corporate goals.
• Build strong collaborative relationships with project managers, divisional and cross functional leads through-out the organization on multiple levels.
• Serves as primary contact for external and internal inquires related to program. Manages applicable vendor/auditor/regulator relationships, inclusive of calls, site visits, audits, consultants and preparation of staff.
• Coordinates collection and submission of evidence required to meet program requirements and assesses compliance.
• Oversees development, contracting process, implementation and compliance of delegation/vendor agreements related to program. In collaboration with business areas, define content, oversight activities and reporting. Monitors agreements to ensure compliance is maintained.
• Provides governance and oversight to program team rooms, artifacts and schedules.
• Organize, coordinate and facilitate regular program reviews/meetings with other team members and cross functional stakeholders to foster coordination and communication. Provides oversight to ensure consistency in approach.
• Plans, directs and coordinates matrixed team(s) activities to manage and implement interrelated projects/activities from contract/proposal initiation to final operational stage.
• Determines, monitors, and reviews all program economics to include costs, operational budgets, staffing requirements, resources, and risk.
• Formulates contingency plans to address schedule revisions, manpower adjustments, fund allocations and work requirements.
• Controls program requirements, scope, and change management issues.
• Facilitates management communication, focusing on critical path issues, risks and mitigation approaches.
• Selects and applies appropriate tools to accurately estimate and plan the work of teams or project groups within agreed policies. Produces work plans according to required standards. Works with colleagues to produce/recommend/develop short term and long-term plans.
• Establishes appropriate metrics for measuring key program criteria and monitors results to those metrics.
• Conduct ongoing competitive intelligence and best practices in collaboration with other internal departments and evaluates for potential implementation. Maintains currency on emerging technologies, project management techniques, regulatory/accreditation requirements related to program. Attend classes, training seminars, and conferences relevant to program. Provide training and guidance to staff. Implement plans to incorporate new requirements into all impacted regions of the Corporation.
• Provides education, assistance and coaching to staff involved in quality improvement (QI) and accreditation activities using the latest quality improvement methods, measurement, analysis and performance tracking. Trains and mentors’ stakeholders on requirements.
• Coaches and counsels members of cross-functional teams to accomplish activities, meet established schedules or resolve technical/operational issues.
• Monitors and evaluates quality of performance and product from all work within scope of responsibility.
• Fosters an environment of continuous improvement. Constantly exploring ways to increase efficiencies and productivity, reducing waste, and reducing costs.
• Advance a culture of excellence rooted in CX guiding principles.
• Ensures confidentiality of information used consistent with New York State Education Law and Public Health Law.
• Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other functions as assigned by management.

Minimum Qualifications:

• Bachelor’s degree in Nursing, Business or Healthcare Administration, Analytics, Project Management or related fields with a minimum of 5 years of related work experience. Master’s degree preferred.
• In lieu of degree, a minimum of 11 years of related work experience.
• Minimum of 3 years of project management. PMI/PMP certification preferred.
• Applied knowledge of quality improvement, accreditation and regulatory compliance.
• Demonstrated leadership skills, quality principles, proficiency in problem solving and quality tools/techniques.
• Knowledge of basic statistical concepts and survey design skills preferred.
• Demonstrated skills in forming and fostering high performance, cross-functional teams.
• Strong communication skills required, including ability to effectively communicate verbally and in writing, internally and externally and across the organization.
• Strong coaching and facilitation skills to drive improvement and matrix ownership and change.
• Communicates effectively with users/customers and colleagues across a range of disciplines and all levels of management.
• Strong understanding and application of vendor management skills.
• Very strong analytical and business process development skills.
• Demonstrated success in working in a fast-paced environment.
• Demonstrated competence in staff leadership and project leadership tasks.
• In-depth knowledge of application delivery, management structures and reporting procedures.
• Demonstrated experience in integrating enterprise applications.
• Demonstrated experience managing teams executing under multi-phased and multi-deployment project schedules.
• Demonstrated experience communicating with senior management in various formats, informal discussions, written reports, scheduled meetings and executive level presentations.
• Knowledge and experience working in the healthcare, health insurance or similar industry.
• Knowledge of federal, state, and accreditation standards including NCQA, CMS, IHI, AHRQ, NQF and NYSDOH Reporting Requirements. Maintains current and thorough understanding of federal and state regulations for all lines of business as it relates to job responsibilities preferred.

Physical Requirements:

• Ability to work while sitting and/or standing while at a workstation viewing a computer and using a keyboard, mouse and/or phone for three (3) or more hours at a time.
• Typical office environment including fluorescent lighting.
• Ability to work in a home office for continuous periods of time for business continuity.
• Ability to travel across the health plan service regions as needed.
• Ability to lift, carry, push or pull 15 pounds or less.
• Manual dexterity including fine finger motion required.
• The ability to hear, understand and speak clearly while using a phone, with or without a headset.

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In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer

Compensation Range(s):
E6: $79,068 - $142,322

The salary range indicated in this posting represents the minimum and maximum of the salary range for this position. Actual salary will vary depending on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate to the position’s minimum qualifications, in addition to internal equity. The posted salary range reflects just one component of our total rewards package. Other components of the total rewards package may include participation in group health and/or dental insurance, retirement plan, wellness program, paid time away from work, and paid holidays.

Please note: There may be opportunity for remote work within all jobs posted by the Excellus Talent Acquisition team. This decision is made on a case-by-case basis.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.