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Job Description

Manage small programs or a phase of a larger program. Provide full program management including needs analysis, program maintenance, administration and monitoring, data analysis, program evaluation, and vendor/contract administration if applicable. May also make recommendations for changes or modifications for assigned program and implement as needed.

What You'll Do

+ Manage/administer smaller programs or a phase of a larger program to ensure that prescribed activities are carried out in accordance with program objectives.

+ Assess needs and coordinate resources to enhance existing programs.

+ Monitor the progress of program components to ensure the overall goals, schedules, and benefits of the program will be met.

+ Document and present program results through operational reports, outcomes studies, presentations and publications. Prepare program reports for superiors.

+ Recommend and/or implement program and process changes as needed to achieve program goals and objectives.

+ May have budget responsibilities to control expenditures in accordance with budget allocations, together with the conformance to timing, limits and usage of funding as agreed upon in the spending plan for the assigned program.

+ May handle vendor management and administer program contracts to ensure vendors meet service level agreements if applicable.

+ Review reports and records of activities to ensure progress is being accomplished toward specified program objective and modify or change methodology as required to redirect activities and attain objectives.

+ Developing HEDIS project plans.

+ Cross-departmental collaboration and stakeholder education.

+ Responsible for DSNP HEDIS program management which includes HEDIS Roadmap, production runs, admin refresh, reporting, etc.

+ Perform compliance related functions including, but not limited to: CCIP, program descriptions, HPMS memos, QIC coordination and facilitation, policy coordination.

+ Support annual HEDIS functions such as: rate review, HEDIS roadmap, Medical Record Review (including overreading), analyze rates and trends, etc.

+ Other ad hoc duties as assigned.

What You'll Bring

+ Bachelor's degree or advanced degree (where required)

+ 3+ years of experience in related field

+ In lieu of degree, 5+ years of experience in related field

+ Knowledge of DSNP clinical quality improvement operations and HEDIS

Bonus Points

+ Strong analytical, organization, and problem-solving skills

+ Strong written and verbal communication skills and ability to successfully interact with all levels of management

+ Knowledge of Blue Cross NC or prior healthcare payer experience strongly preferred

What You’ll Get

+ The opportunity to work at the cutting edge of health care delivery with a team that’s deeply invested in the community

+ Work-life balance, flexibility, and the autonomy to do great work

+ Medical, dental, and vision coverage along with numerous health and wellness programs

+ Parental leave and support plus adoption and surrogacy assistance

+ Career development programs and tuition reimbursement for continued education

+ 401k match including an annual company contribution

+ Learn more (https://careers.bluecrossnc.com/global/en/benefits)

Salary Range

At Blue Cross NC, we take great pride in a fair and equitable compensation package that reflects market-price and our starting salaries are typically planned near the middle of the range listed. Compensation decisions are driven by factors including experience and training, specialized skill sets, licensure and certifications and other business and organizational needs. Our base salary is part of a robust Total Rewards package that includes an Annual Incentive Bonus*, 401(k) with employer match, Paid Time Off (PTO), and competitive health benefits and wellness programs.

_*Based on annual corporate goal achievement and individual performance._

$68,200.00 - $109,100.00

Skills

Budgeting, HEDIS, Office Administration, Process Improvements, Program Administration, Program Documentation, Program Evaluations, Program Implementation, Program Management, Project Management, Resource Allocation

About Us

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians.

Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all.

Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Authorization to Work in the United States

We use E-verify to confirm authorization to work in the United States. To learn more about E-Verify, including your rights and responsibilities, please visit E-Verify Overview (https://www.e-verify.gov/employees/e-verify-overview) for English or Visión General de E-Verify (https://www.e-verify.gov/es/empleados/vision-general-de-e-verify) for Español.

Request Accommodations

Blue Cross NC provides reasonable accommodations to applicants with disabilities. If you need a reasonable accommodation for any part of the application or hiring process, please notify HR at [email protected] .

For most roles, you can choose where to work - fully remote in one of the states listed below, in the office, or a hybrid of the two:

Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming