Risk Programs Manager QVBC

The Quality and Value Based Care area strives to develop a "best in class" service model and experience for our senior population. Our team works closely with other associates and business areas that support Medicare Advantage members in an effort to meet and exceed customer expectations and continue driving toward strategic improvement.

The Risk Programs Manager will be responsible for developing, organizing and directing activities and associates within the Division. This position is responsible for planning, implementing, coordinating and deploying analytical strategies that appropriately maximize the Company's risk posture as it relates to risk adjustment under Healthcare Reform and Medicare Advantage. This position will be responsible for oversight of standards and regulations related to risk adjustment programs and compliance with those requirements. In addition the position will work collaboratively with business areas to identify risk and quality improvement opportunities based on analysis of key indicators, and monitor the operational impact of initiatives. The incumbent establishes and maintains partnerships with divisional executives, managers and key personnel and external vendors in order to fulfill corporate objectives and move toward established improvement targets. In addition, the incumbent coaches and develops associates, oversees research and analysis, and incorporates policies and practices to ensure execution of a sound program to maintain integrity of internal procedures.

• Bachelor's Degree
• Minimum of five years of relevant experience in areas such as the healthcare field, finance or accounting, mathematics or statistics, data analysis techniques and interpretation, business, compliance and regulations related to risk adjustment or quality standards, and/or methods for quality improvement
• Management experience; or experience in a position requiring demonstrated leadership skills and 3 years of experience with at least one of the following skills; (1) relevant healthcare risk adjustment knowledge, (2) advanced healthcare reporting/analysis, or (3) clinical data analytics
• Knowledge of the healthcare field, quality improvement strategies, regulations related to quality, project management, and/or methods for data analysis techniques and interpretation
• Experience with project management and continuous improvement, along with organizational and analytical skills in order to independently identify and evaluate opportunities for improvement related to Key Quality Indicators (KQIs)
• Proficient in Microsoft Word, Excel and PowerPoint
• Strong communication skills, both orally and written, along with positive collaboration and excellent interpersonal skills
• High degree of problem solving and diagnostic skills to be used to develop creative, practical, and cost-effective recommendations for improvement
• Experience interpreting complicated and detailed information and communicating those interpretations in a succinct manner
• Experience leading enterprise wide projects and influencing decisions and directions
• Experience negotiating and integrating conflict-management skills into challenging situations
• Knowledge of the use of healthcare data
• Experience analyzing large datasets using tools such as Crystal Reports, SQL, Excel, etc.
• Already possess or willingness to obtain within 2 years of hire into this position one or more of the following certifications; Project Management Professional (PMP), Certified Internal Auditor (CIA), Certified Professional in Healthcare Quality (CPHQ), Certified in Health Care Quality and Management (CHCQM), Certified Risk Adjustment Coder (CRC), Certified Professional Coder (CPC) and/or Six Sigma/Green Belt preferred
  

The work location for this position will be hybrid (onsite/remote).

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We appreciate your interest in Blue Cross and Blue Shield of Alabama 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination.
Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association