Quality Improvement Project Manager

Company :

Highmark Wholecare

Job Description : 

JOB SUMMARY

This job conducts project management of compliance-related projects conducted by assigned business owners applicable departments for any type of regulatory requirement that is or may be applicable to the organization, as well as delegation oversight requirements across all applicable regulatory requirements specifically related to NCQA Accreditation, and SNP Model of Care. Maintains subject matter knowledge and expertise to educate and direct business owners on reviewer expectations to support compliance with current, new, and/or revised standards and guidelines. Demonstrates the ability to identify potential business impacts/compliance gaps across the organization and collaborates with and/or directs business owners on the development of solutions to mitigate risk. Reviews documentation developed by business owners to support compliance on an ongoing basis to ensure continuous audit preparedness. Represents the organization with external stakeholders (e.g., CMS, NCQA, BCBSA, state regulatory agencies, etc.) on regulatory requirement related matters. Project management of business owners within department for regulatory compliance-related tasks.

ESSENTIAL RESPONSIBILITIES

• Work with business and technical organizations to drive out program strategy and approach. 
• Organize, plan, and maintain Program roadmap consisting of cross-functional activities/projects.
• Work with business and technical organizations to assemble project teams. 
• Lead Project Managers and Program team in the development and maintenance of comprehensive plans for a defined program.
• Work with Executive Sponsor and Business Owner of a Program, and other management as required, to achieve the Program objectives. 
• Acquire understanding of the business objectives for an assigned area."
• Monitor, evaluate and report on Program status inclusive of scope, schedule, budget and alignment to Program and strategic goals. 
• Direct corrective action as needed to maintain the viability of the Program.
• Develop and maintain positive customer relationships.
• Deliver presentations of project status to effectively communicate throughout the project lifecycle.
• Adhere to the Organization's project management methods, project lifecycle methodologies, and audit requirements. 
• Support and contribute to the improvement of project management methods and practices.
• Other duties as assigned or requested.

EDUCATION

Required

• High School Diploma or equivalent

Substitutions

• None

Preferred

• Bachelors’ Degree in Clinical or Healthcare related business field 

EXPERIENCE

Required

• 1 - 4 years in a Project Manager role for application development projects and/or in a Project Leadership role for same
• Solid leadership skills
• Solid organizational and planning skills
• Experience with an industry standard software development  lifecycle
• Very good verbal and written communication skills
• Strong interpersonal skills
• Team building skills

Preferred

• 2 years of combined experience in Quality Improvement, Utilization Management, Disease Management, Preventive Health or Case Management in a managed care health plan environment
• 2 years of leadership experience in NCQA survey preparation
• 2 years of managed care health plan experience in Medicaid / Medicare
• Understanding of health care diseases or conditions, their management, health care delivery systems and processes

LICENSES AND CERTIFICATIONS

Required

• None

Preferred

• Certification in Quality Management Principles/Project Management and /or Lean Six Sigma
• Certified Professional in Healthcare Quality

SKILLS

Required 

• Experience with customer relationship management
• Presentation skills
• Negotiation skills
• Experience with conflict resolution
• Experience with Risk Mitigation Planning

Preferred

• None

Language (Other than English)

None

Travel Requirement

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches/trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Does Not Apply

Physical work site required

Yes

Lifting: up to 10 pounds

Occasionally

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Does Not Apply

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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