Manager, Medicare Advantage Risk Adjustment and Health Services

Quality Improvement Coach

Oversees direct coaching support to a physician / provider practices to make improvements in systems and delivery of care. Ensures establishment and maintenance of excellent relationships with network hospitals, physician and / or designated practices, and their representatives. Leads activities related to outreach and coaching support to designated practices. Leads project quality measurement, reporting, and communications activities. Plans detailed special projects and leads Quality Improvement (QI) project planning teams and workgroups. Provides direct QI coaching to practices as needed, and / or will work in partnership with any existing practice or health system QI coaches (where they exist) to build QI capacity within practices to meet improvement goals.

This position is full-time (40-hours / week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8 : 00AM-5 : 00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 17 Technology Circle Columbia, SC, 29203.

To qualify for this position, you'll need the following :

• Bachelor's Degree
• Four years of job-related work experience or associate's and two years job related work experience.
• Six years of healthcare system management, quality improvement, provider network, health claims management or a combination of these. Two years' experience with direct health programs. Two years project coordination experience. Leadership experience. (all may be concurrent).
• Knowledge / understanding of automated medical management systems and claims processing systems. Experience in health care office environment with demonstrated responsibility for process improvement and quality improvement. Knowledge of quality improvement concepts, and ability to learn models and methods including clinical practice transformation models and methods. Excellent verbal communication and presentation skills. Ability to demonstrate excellent writing and written communication skills. Excellent relationship management skills. Ability to work independently and to collaborate with teams of individuals in diverse settings, with solution-oriented approach. Good judgment. Strong leadership skills. Demonstrated customer service and organizational skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Working knowledge of project management tools.
• Microsoft Office. Must have qualification as certified risk coder (CRC)

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.