At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for managing and directing activities involved in enterprise project management and developing, documenting, and administering enterprise quality and accreditation strategies, activities and programs that comply with accreditation standards (NCQA, URAC), federal regulations (ACA, CMS Medicare and Medicaid), and plan state regulations. Ability and willingness to travel.

Please note, this is a HYBRID position and requires in-office hours 3 days a week in the respective location.

Responsibilities include but are not limited to:

1. Lead and direct the activities of the Enterprise Quality Improvement and Accreditation Department.
2. Develop and implement Enterprise Quality Improvement and Accreditation programs that maximize efficiency and outcomes. Evaluate programs annually. Provide management direction and support to programs as needed.
3. Lead the implementation and management to transition to a centralized and integrated accreditation department.
4. Ensure Exchange accreditation readiness and completion of accreditation activities. Achieve and sustain accreditation as required by ACA regulations.
5. Prepare and manage budget expenses for the department and for corporate quality programs and activities, accreditation reporting (i.e., HEDIS) and satisfaction survey (i.e., CAHPS). Ensure that all projected workload is completed efficiently within budgeted parameters. Ensure appropriate resources are available to support the quality program.
6. Develop and implement committee structures to support the Enterprise Quality Programs.
7. Ensure quality reporting, including HEDIS and CAHPS, is completed to support the Quality Programs, accreditation and compliance with state and federal regulations. Ensure compliance with ACA quality reporting including physician quality reporting. Evaluate performance and facilitate improvement initiatives when indicated.
8. Review new state and federal legislation and regulatory guidance, and identify impact to Quality and Accreditation areas. Assist Plans in efforts to ensure compliance.
9. Ensure delegation oversight functions and reporting is completed for entities performing delegated functions.
10. Ensure complaints, grievances and appeals are handled according to various regulatory requirements.
11. Perform Divisional Privacy Office role and responsibilities for Quality and Accreditation Department.
12. Manage and monitor project management, program management or management of special initiatives. May lead projects or initiatives.
13. Assist in optimizing engagement of key stakeholders across the Enterprise.
14. Communicate and interact effectively and professionally with co-workers, management, customers, etc.
15. Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
16. Maintain complete confidentiality of company business.
17. Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.

JOB REQUIREMENTS:

* Master of Business Administration (MBA) with health care focus
* 10 years’ experience in the health insurance industry with large, multi-state payer(s).
* Knowledge of health insurance products, programs, systems, processes, industry and trends and medical terminology.
* 4 years management experience.
* Analytical skills, negotiation skills, and budget experience.
* Knowledge of Continuous Quality Improvement (CQI), Strategy, and Change Management concepts.
* Knowledge of external accrediting agency requirements, i.e., NCQA.
* Verbal and written communication skills including interpersonal skills, consensus building skills and
presentation skills.
* Knowledge of Managed Care products and programs.
* PC proficiency including Microsoft Office.
* Ability and willingness to travel.

*Overseeing the annual budget and allocating resources for various projects and operational needs.

*Translating needs and initiatives into compelling business cases.

*Conducting cost-benefit analyses to justify investments and ensure ROI

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$161,500.00 - $299,700.00

Exact compensation may vary based on skills, experience, and location.