Lead Quality Management Analyst-DSNP

Pay Range:

Please emailif you are a candidate seeking a reasonable accommodation for the application and/or interview process.

At BCBSRI our greatest resource is our people.

We come from varying backgrounds different cultures and unique experiences. We are hard-working caring and creative individuals who collaborate support one another and grow together. Passion empathy and understanding are at the forefront of everything we donot just for our members but for our employees as well.

We recognize that to do your best work you have to be your best self.
Its why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health dental and vision insurance as well as programs that support your mental health and well-being. We pay competitively offer bonuses and investment plans and are committed to growing and developing our employees.

Our culture is one of belonging.
We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where youre at in the organization youre an integral part of our team and your input thoughts and ideas are valued.

Join others who value a workplace for all.
We appreciate and celebrate everything that makes us unique from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

Were dedicated to serving Rhode Islanders.
Our focus extends beyond providing access to high-quality affordable and equitable care. To further improve the health and well-being of our fellow Rhode Islanders we regularly roll up our sleeves and get to work (literally) in communities all across the statebuilding homes working in food pantries revitalizing community centers and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can our associates receive additional paid time to volunteer.

What you will do:

• Lead the management of behavioral health and clinical quality programs to support an integrated cost-effective care model that enhances member quality of life.
• Mentor staff by setting goals evaluating performance and conducting regular chart/ call audits.
• Provide an oversight of program operations. Research and recommend changes and improvements with a primary focus on member outcomes. Triage program issues to internal stakeholders for resolution and process improvement.
• Establish and monitor key performance metrics for quality programs. Ensure establishment of processes to report on and monitor metrics closely and recommend mitigating actions when risk exists.
• Collaborate across departments to align quality initiatives with strategic goals and ensure successful project outcomes.
• Ensure department complies with all applicable regulatory guidelines including NCQA DOH CMS URAC HIPAA State of RI Workers Comp Protocol DOH EOHHS etc.
• Train the clinical team on the development of the member Care Plan and its effective use as a tool to drive member interactions and engagement.

What youll need to succeed:

• Bachelors degree in nursing or related field or an equivalent combination of education and experience with active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC) or a Behavioral Health license (LICSW LMHC LMFT) or a bachelors degree in health information administration or an equivalent combination of education and experience.
• Three to five years of experience in case management and or disease management and up to3- 5 years experience with clinical quality activities

• Possession and maintenance of Case Management Certification (CCM) within 3 years of tenure in the position
• Knowledge of project management methodologies
• Knowledge of business process improvement techniques and strategies
• Excellent verbal and written communications skills
• Ability to create corrective action plans
• Ability to interpret regulatory requirements and translate into business requirements
• Ability to lead and manage projects
• Ability to thin creatively and to drive innovation
• Ability to interface with employees at all levels
• Ability to effectively navigate ambiguous situations with limited direction
• Excellent organizational skills and ability to successfully prioritize multiple tasks
• Ability to handle multiple priorities/projects
• Ability to set and maintain quality standards
• Ability to develop and maintain effective and collaborative working relationships
• Strong and effective decision-making skills
• Ability to mentor coach and provide guidance to others
• Proficiency with Microsoft Suite of products (i.e. Word Excel PPT etc.

The extras:

• Masters in nursing or healthcare administration or related field
• Experience overseeing quality improvement activities
• Experience overseeing program operations
• Knowledge of regulatory guidelines
• Clinical experience

Location:
BCBSRI is headquartered in downtown Providence conveniently located near the train station and bus terminal. We actively support associate well-being and work/life balance and offer the following schedules based on role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states pending approval from the Human Resources Department: Arizona Connecticut Florida Georgia Louisiana Massachusetts North Carolina Oklahoma Rhode Island South Carolina Texas Virginia
  

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do and it strengthens our ability to meet the challenges of todays healthcare industry. BCBSRI is an equal opportunity employer.

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