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Manager, Program Management Clinical
4 months ago
Your Role
The Quality Review team completes internal audits of front-line staff and vendors to ensure alignment with department processes and regulatory compliance. Quality Reviewers also provide coaching and work closely with business leaders to drive optimal results. The Manager of Quality Review will report to the Senior Manager of the Quality & Communications team. In this role you will be responsible for leading the team in numerous quality initiatives, providing and presenting data to business unit leaders, and working closely with the Senior Manager on internal process improvement. Our leadership model is about developing great leaders at all levels and creating opportunities for our people to grow – personally, professionally, and financially. We are looking for leaders that are energized by creative and critical thinking, building and sustaining high-performing teams, getting results the right way, and fostering continuous learning.
Your Work
In this role, you will:
Be a people leader responsible for leading a small team of clinical and non-clinical Quality Reviewers, manage day-to-day operations and provide staff support Monitor the regulatory compliance and quality of service provided to members through internal case review Monitor the execution of internal processes and procedures as requested by business unit leaders; ensure compliance with regulatory, legal, and contractual requirements, as well as accreditation and Blue Shield standards Communicate with internal and external leaders to ensure audit tools meet all regulatory and process expectations Coordinate all information, provide data analysis and respond to the appropriate parties; participate and present in committee meetings Be responsible for strategic alignment and integration across projects/programs in support of business unit process and administrative efficiency Be responsible for medium complexity projects/programs, manage them from initiation through delivery and monitor for continuous improvement Exercise independent judgement in developing methods, techniques and evaluation criterion for obtaining results