Manager Risk and Quality Assurance

This role has oversight responsibility for all risk and quality assurance studies required by regulators, the Blue Cross Blue Shield Association (BCBSA), accreditation bodies, executive management, plan partners, group customers, and employee-level performance.

Responsibilities

• Perform management responsibilities including hiring, termination decisions, coaching, development, rewards, recognition, performance management, and staff productivity.
• Plan, organize, staff, direct, and control the day-to-day operations of the department; develop and implement policies and programs; may have budgetary responsibility and authority.
• Manage a global team responsible for accreditation and quality assurance across the enterprise, including:
  • BCBSA's Member Touchpoint Measures (MTM), Licensee Desk Level Audit (LDLA), and Federal Employee Program (FEP) Quality Program.
  • National Committee for Quality Assurance (NCQA) compliance.
  • Joint Commission accreditation compliance.
  • Quality measures required by state regulators.
  • Quality measures related to group and partner plan contractual performance guarantees/service level agreements.
  • Employee performance quality.
• Assess and guide business owners on activities required to ensure ongoing quality and accreditation program compliance; revise departmental work plans based on results; conduct quality checks of all documents prior to formal submission.
• Interact with internal and external personnel at all levels to communicate risks, expectations, and alternative strategies for operational performance and program compliance.
• Collaborate and present with Risk Partner and Business Unit executives in customer and regulator meetings (e.g., Insurance Department, HHS/CMS, Department of Health) on key risk and compliance activities, issues, and remediation.
• Manage teams conducting internal mock audits to ensure continuous audit preparedness, identify improvement opportunities, communicate results to business owners, and report to management.
• Other duties as assigned or requested.

Requirements

• Bachelor's Degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, or related field (or 6 years of related and progressive experience in lieu of degree).
• 5 years of interaction with regulators, auditors, and oversight bodies.
• 3 years in a leadership role, preferably in Quality, Accreditation, Audit, or Compliance within Healthcare or a related industry.
• 3 years overseeing quality, accreditation, audit, and/or compliance teams.

Preferred Qualifications

• Master's Degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, or related field.
• Certified Public Accountant (CPA) or Lean/Six Sigma certification.

Skills

• Expert knowledge of business and technology processes, risk and control frameworks, and assessment methodologies, particularly in healthcare (payer and provider).
• Knowledge of regulatory guidelines, vendor management, sourcing, procurement, and vendor assessments.
• Strong resource and project planning capabilities, decision-making skills, and a history of results-oriented delivery.
• Effective team building across diverse and cross-campus teams.
• Strong written and verbal communication skills for diverse audiences (senior management, board, peers, and team).
• Strong relationship-building skills and ability to influence with or without authority in a matrixed organization.
• Highly developed leadership qualities with the ability to motivate and inspire teams to achieve superior results.
• High capacity for analytical thinking, interpreting information, applying judgment, and making strategic decisions.

Working Conditions

• Office-based position.
• Regularly teaches/trains others.
• Travel requirement: 0% - 25% (frequently between office and various work sites).
• Physical work site required.
• Lifting requirements:
  • Up to 10 pounds: Constantly
  • 10 to 25 pounds: Occasionally
  • 25 to 50 pounds: Rarely

Pay

Base pay range: $102,700.00 - $164,600.00. Pay is determined by qualifications, experience, expected contributions, internal peer equity, market, and business considerations. Geographic differentials may apply for certain locations.