Director Quality Improvement

Direct and oversee the development and implementation of clinical and service quality initiatives, ensure compliance with applicable regulatory and accrediting bodies (NCQA and URAC), and promote quality improvement activities, especially in partnership with our Provider Network which includes, partnering with network innovation, PCMH, and Provider Service consultants to support successful and meaningful program outcomes. Directs the development, implementation, and evaluation of Quality improvement action plans for clinical quality improvement activities. In addition, this position drives improvement efforts through collaboration with internal and external stakeholders.

Job Description:

Job Responsibilities

• Administers the quality improvement program for the division and provides operational leadership for HEDIS reporting and interventions, member/provider satisfaction surveying, appeals processing, quality assurance activities, QI reporting, and QI new business development. Oversee, plan and implement HEDIS/CAHPS/ Satisfaction surveys related to clinical improvement efforts, consistent with the overarching strategy for quality and enhancing patient outcome.
• Oversees annual quality documents (program description, workplan and program evaluation)  and facilitate their review by the BCBST Board of Directors. Oversees QI reporting including analyzing validity of Quality Improvement data/reports from a clinical perspective. Oversees the member quality of care complaint process, and appeals process within the division.
• Provides leadership and makes recommendations for provider clinical risk management, credentialing, re-credentialing in the areas of medical record reviews, Clinical Quality indicators, performance and quality of care actions. Provides supervision and leadership to QI representation in new business activities.
• Develops the annual operating and capital budgets to sufficiently meet departmental needs and ensures that the department stays within budget; responsible for hiring and managing staff.

Job Qualifications

Education

• BS degree in Nursing with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. 

Experience

• 8 years - Clinical experience required
• 4 years - Varied clinical experience in a health care management environment required

Skills\Certifications

• Demonstrated presentation and team facilitation skills
• Working knowledge of URAC, NCQA and CMS accreditations
• Excellent oral and written communication skills
• Effective and concise presentation skills
• Proven effective supervisory and leadership traits to manage and direct others
• Appreciation of cultural diversity and sensitivity towards target population

Job Specific Requirements: 

Previous Quality experience is a Plus.

This position is subject to and requires acceptance of BCBST's standard Non-Competition Agreement

Preferred Skills:

Number of Openings Available:

1

Worker Type:

Employee

Company:

VSHP Volunteer State Health Plan, Inc

Remote-First Statement:

BCBST is a remote-first organization with many employees working primarily from their homes.  Each position within the company is classified as either fully remote, partially remote, or office based.

BCBST hires employees for remote positions from across the U.S. with the exception of the following states:  California, Massachusetts, New Hampshire, New Jersey, and New York.  Applicants living in these states may move to an approved state prior to starting a position with BCBST at their own expense.  If the applicant moves to Chattanooga, TN, they may be eligible for relocation benefits.

Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST is an Equal Opportunity employer (EEO), and all employees and applicants will be entitled to equal employment opportunities when employment decisions are made. BCBST will take affirmative action to recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

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