Blue Cross NC aspires to be best in the nation in quality of care and to advance the science of quality measurement and improvement. To help us reach these ambitious goals, we need a creative, driven and thoughtful leader for our growing and dynamic Quality Operations and Performance team to support our strategy of value transformation of health care delivery.
This leader will develop the vision and drive implementation toward the triple aim of improving health outcomes, reducing cost of care, and improving the overall care experience for all members and accounts.
Provide leadership and oversight for:
Quality Improvement programs for all product lines including Medicare, Medicaid, Commercial, FEP, Exchange ACA, State Health, and all other lines of business.
Collaboration with internal and external business and technical teams for quality measurement (HEDIS, CAHPS, HOS, PROMs) and drive quality improvement in supporting Blue Premier and MA Quality Improvement Programs (QIP) to achieve NCQA accreditation, Medicare 4 Stars rating, and Exchange QRS 4 Star rating.
Quality performance measure alignment and transformation from process driven quality measures to a member centric outcomes measurement system.
Improve quality of care for our members through the development of Blue Cross NC’s quality strategy and oversight of Quality Improvement (QI) programs.
Facilitate development and monitoring of the annual Corporate QI Program descriptions, work plans and program evaluations and ensure they meet corporate mission, vision and quality goals.
Oversee all production and analyses of HEDIS, CAHPS, HOS, Stars ratings, NCQA accreditations.
Keep abreast of industry trends, both national and local, and synthesize such information to proactively identify ways to improve quality of care while concurrently ensuring all applicable accreditation and/or regulatory standards are met.
Partner with providers and BCNC’s internal provider engagement team to drive quality improvements that positively impact patient care; provide oversight of clinical data strategy and quality performance measurement in support of these efforts.
Lead Enterprise effort to maintain BCNC’s quality compliance and NCQA accreditation by providing interpretation of standards and guidance to Enterprise departments (including CGO, Web team, Pharmacy, MHPO, Network Management, Compliance, Sales and Marketing).
Lead Enterprise efforts to achieve and maintain Medicare and ACA Stars; provide expertise in relation to the CMS Stars requirements
Utilize expertise in QM/QI theory and methodologies (including TQM, Lean Six Sigma, and statistical analysis) to build quality programs driven to member centric outcomes measurement.
Oversee vendor relationships for all quality programs.
Build strong quality management and performance measurement team
Current clinical license required (MD, RN, MSW or other related fields).
Bachelor’s degree and ten years of related experience required (i.e. quality management, healthcare operations management, clinical project/program and data management).
5 years direct people leadership experience required
Strong people leadership and team building skills through focus on empowerment, setting clear expectations and accountabilities and ongoing feedback.
Ability to partner and influence to successfully execute within matrixed environment and people first culture
Strong emotional intelligence, including verbal and written communication and presentation skills
Ability to focus and plan around strategic goals with appropriate attention to process and details for execution.
Six sigma or PMP certification preferred
AHIP, ACPE, or other leadership training certifications preferred
Internal Number: RQ0005702
About Blue Cross NC
Since 1933, Blue Cross and Blue Shield of North Carolina has offered its customers high quality health insurance at a competitive price and has led the charge toward better health and more customer-focused care in our state. We are a fully taxed, not-for-profit North Carolina company that serves more than 3.89 million customers. Our mission is to improve the health and well-being of our customers and communities and our vision is to be the model of health transformation through an unwavering commitment to affordability, quality, and exceptional experience.
To realize this vision, our strategy includes the following:
• We will shift an increasing percentage of provider reimbursement – as much as 50% by
the end of 2019 – into models that incentivize clinical excellence and reduced cost.
• We will become a leader in the science of quality measurement, focusing on outcome-based
metrics as well as making data available to providers and members alike.
• We will drive the adoption of innovation and new technologies that can improve the health
and well-being of our members – with a focus on improving discrete health outcomes.
• We will expand access to a...dvanced primary care by investing in the clinical transformation
of existing primary care practices and the building of new primary care capacity.
• We will expand access to behavioral health care by investing in the clinical transformation
of the existing behavioral health care system and the building of new behavioral health care