Quality and Accreditation Consultant - Capital Blue Cross

Position Description

Base pay is influenced by several factors including a candidate’s qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range displayed has not been adjusted for geographical location. This range has been created in good faith based on information known to Capital Blue Cross at the time of posting and may be modified in the future. Capital Blue Cross offers a comprehensive benefits packaging including Medical, Dental & Vision coverage, a Retirement Plan, generous time off including Paid Time Off, Holidays, and Volunteer time off, an Incentive Plan, Tuition Reimbursement, and more. 

At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.”

The Quality and Accreditation Consultant will provide focused attention and support for the organization-wide quality improvement efforts that support Capital’s overarching quality improvement program and strategy. This includes all regulatory and accreditation activities, including the various initiatives that support compliance with the National Committee for Quality Assurance (NCQA) standards and the required filings with the Pennsylvania Department of Health (DOH) and the Pennsylvania Insurance Department (PID). This position will work cross-functionally and collaboratively to help lead, coordinate, monitor, and report on quality improvement and the various NCQA accreditation standards and initiatives across the organization in addition to supporting our internal and external quality committees.

Responsibilities and Qualifications

• Assists in the development, implementation, measurement and tracking of complex cross-functional quality improvement and NCQA accreditation activities to ensure compliance with NCQA accreditation and other regulatory standards. Works collaboratively with other departments to ensure a comprehensive approach and have a shared understanding of roles and responsibilities
• Assists with the cross-departmental initiatives and improvement efforts to further develop and promote Capital’s quality improvement program in alignment with the NCQA quality improvement standards
• Leads the cross-departmental initiatives and improvement efforts for assigned NCQA standards.
• Acts as a key resource in the analysis and interpretation of data to assist in identification of operational improvements and strategic planning
• Acts as a subject matter expert for the organization on assigned NCQA accreditation standards. Educates key stakeholders about quality improvement and NCQA accreditation guidelines, standards, processes and requirements
• Assists in the coordination and completion of all annual quality program documents, including the quality improvement program description, quality improvement program evaluation, and quality improvement work plan, among others.
• Supports department leadership in business ownership of the assigned NCQA standards and all required activities therein. Assists in collecting and maintaining all required documentation in compliance with these standards and utilizes feedback to update policies/procedures/operations accordingly
• Exercise independent judgment when developing work plans, analyses, and communications
• Use quality improvement methodologies, tools, and approaches in deliverables and initiatives
• As needed, coordinates mock file reviews as required by assigned NCQA accreditation standards
• Provides recommendations on results of file review to ensure compliance with NCQA standards
• Collaborate with appropriate business units to ensure compliance with NCQA Delegation oversight requirements.

Skills:

• Excellent interpersonal interaction with the ability to lead cross-departmental workgroups and committees and bring groups to consensus
• Ability to influence others to be accountable for assignments, improvement processes, and drive performance excellence
• Proven ability to influence without authority
• Ability to provide sound project direction, interact effectively with leadership, and facilitate project assessments, present findings, status, and recommendations in a professional manner
• Strong, professional, clear verbal communication skills
• Proficient problem solving and critical thinking skills
• Detail oriented and strong organizational/project management skills
• Strong computer skills, must be proficient with Microsoft applications; Excel, Word, Visio, and PowerPoint
• Able to effectively present and facilitate group meetings and presentations
• Ability to effectively communicate in written form in order to prepare detailed reports that accurately convey the issue/problem/situation and recommended action in a clear and concise manner
• Ability to focus on details, but with an overall understanding of the business
• Ability to understand and align with strategic direction as well as develop tactical plans and drive performance

Knowledge:

• Knowledge of current and emerging industry trends in health care plans and quality improvement practices
• Understanding of regulatory requirements related to quality improvement including but not limited to NCQA, CMS, in addition to state law

Experience:

• Experience leading complex, multi-departmental projects and initiatives and driving results to achieve shared goals
• Minimum of 3 years of health plan/managed care experience

Education and Certifications:

• Master’s Degree preferred, minimum Bachelor’s degree required in a health related field and/or an active health care licensure
• Clinical experience preferred

Physical Demands:

• While performing the duties of the job, the employee is frequently required to sit, use hands and fingers, talk, hear, and see. The employee must occasionally lift and/or move up to 5 pounds.

About Us

We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a diverse and caring team of supportive colleagues, and be encouraged to volunteer in your community.  We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career.     And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.