Supervisor, Medicare Advantage Quality Operations

Description

Position Purpose

We are currently hiring for a Supervisor Medicare Advantage Quality Operations, to join BlueCross BlueShield of South Carolina.

In this role as a Supervisor Medicare Advantage Quality Operations, you will be responsible for leading Medicare Advantage team initiatives and project oversight including coordinating work efforts among the team and internal departments.

Leading the day-to-day operations and responsible for reporting key metrics to management on a regular basis. Provide guidance for special training, data validation, project implementation and employee coaching.

Meet with management team to review all active and planned work efforts and develop strategic plans based on team specialty.

Schedule review sessions to obtain feedback from staff, troubleshoot issues and ensure that staff have adequate resources to complete assigned projects.

Plan detailed projects and organizes concurrent initiatives through well-prepared staff training and resource alignment.

Shift resources as needed and manages project schedule to reach established goals.

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Logistics

Location : This role is full time M-F 8am-5pm, hybrid (minimum 2 days a week onsite)

What You Will Do :

Responsible for recruiting and hiring, coaching and mentoring, monitoring and evaluation, and addressing all disciplinary issues in a timely manner

Empowers employees for high engagement, job satisfaction, and corporate success. Arranges schedules, training resource plan based on team objectives and needs

Establishes goals and timelines in partnership with management and disseminates information to team for successful deployment.

Conducts meetings and organizes projects to achieve established goals

Plans detailed projects, makes team assignments and oversees initiatives until completion

Conducts and participates in functional area meetings related to current and upcoming activities, review active projects, assess team needs, and ensure the department is on schedule with initiatives

Develops qualitative and quantitative reports to share with management for team progress

May also give presentations or lead discussions among internal and external stakeholders

Responsible for all team activities within specialty area and maintains relationships with internal and external stakeholders

Acts as a subject matter expert and represents manager at both internal and external meetings

Researches external vendor offerings, monitors vendor performance according to service level agreement and makes appropriate recommendations for the business

Thinks proactively for business needs and maintains activities within budget

Ensures data validation, team integrity and compliance for all activities according to CMS Medicare Advantage specifications

Maintains appropriate documentation for all projects and audit materials

May develop and conduct training or assessments for team members to ensure accuracy and consistency in performance

Troubleshoots problems and elevates recommendations to management regarding any issues that may have a negative impact for Medicare Advantage performance

To Qualify for This Position, You Will Need :

Required Education : Bachelors degree OR degree equivalency : 4 years job related work experience or Associate's and 2 years job related work experience

Required work experience : 4 years of project administration, work coordination experience in a healthcare environment or similarly complex environment, including experience in a supervisory role or team lead role OR equivalent military experience in grade E4 or above

Strong organizational, leadership, decision making, analytical, problem solving, interpersonal and project management skills

Excellent verbal and written communication skills

Ability to persuade, negotiate and influence

Highly proficient PC skills

Basic business math proficiency

Analytical and critical thinking skills

Basic knowledge of information systems environments and concepts

Flexibility to adapt to changing business, client and project needs

Ability to balance workload for several work requests simultaneously

Basic understanding of resource planning and organizational impacts

Required software tools : Microsoft office

What We Prefer :

Strong HEDIS experience

Experience educating providers on quality metrics

Registered Nurse

What We Can Do for You :

401(k) retirement savings plan with company match

Subsidized health plans and free vision coverage

Life insurance

Paid annual leave the longer you work here, the more you earn

Nine paid holidays

On-site cafeterias and fitness centers in major locations

Wellness programs and healthy lifestyle premium discount

Tuition assistance

Service recognition

Incentive Plan

Merit Plan

Continuing education funds for additional certifications and certification renewal

What to Expect Next :

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 a recruiter to verify resume specifics and salary requirements.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.