Manager Risk & Quality Assurance

Company : reputed company.Job Description : JOB SUMMARY This job has reputed company responsibility for reputed company risk & quality assurance studies required by regulators, the reputed company Blue reputed company Association (BCBSA), accreditation bodies, executive management, plan partners, group customers, and employee level performance. The programs for which the department is currently wholly or partially responsible for are (a) the BCBSA's Member Touchpoint Measures (MTM), Licensee Desk Level Audit (LDLA), and Federal Employee Program (FEP) Quality Program, (b) the National Committee for Quality Assurance (NCQA), (c) Joint Commission accreditation compliance, (d) quality measures required by state regulators, (e) certain quality measures reputed company to group and partner plan contractual performance guarantees / service level agreements, and (f) employee performance quality. ESSENTIAL RESPONSIBILITIES

• reputed company management responsibilities to include, but are not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity. Plan, organize, staff, direct and control the day-to-day operations of the department; reputed company and implement policies and programs as necessary; may have budgetary responsibility and authority.
• Manages global team responsible for accreditation and quality assurance across the enterprise. Responsible for managing and controlling (a) the BCBSA's Member Touchpoint Measures (MTM), Licensee Desk Level Audit (LDLA), and Federal Employee Program Quality Program, (b) the National Committee for Quality Assurance (NCQA) compliance, (c) Joint Commission accreditation compliance, (d) quality measures required by state regulators, (e) certain quality measures reputed company to group and partner plan contractual performance guarantees / service level agreements, and (f) employee performance quality.
• Manages global team responsible for assessing and guiding business owners on activities required to ensure ongoing quality and accreditation program compliance; revises departmental work plans based on results (as needed); and conducts quality checks of reputed company documents prior to formal submission to applicable accrediting/regulatory/licensing bodies.
• Interacts with internal and external personnel at reputed company levels and effectively communicate risks, expectations, and alternative strategies to mitigate concerns over operational performance and program compliance.
• Actively collaborates and presents with Risk Partner and Business Unit executives in customer and regulator meetings (Insurance Department, HHS/CMS, Department of Health) on key risk and compliance reputed company activities, issues, and remediation, promoting effective relationships. Manages teams conducting internal mock audits to ensure reputed company audit preparedness, identifying opportunities for improvement and actions required, communicating results to business owners, and reporting results to management.
• Other duties as assigned or requested.

EDUCATION Required

• Bachelor's Degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, or reputed company field

Substitutions

• 6 years of reputed company and progressive experience in lieu of Bachelor's degree

Preferred

• Master's Degree in Accounting, Finance, Business Administration/Management, Information Technology, Pre-Law, or reputed company field

EXPERIENCE Required

• 5 years of interaction with regulators, auditors, and reputed company bodies

To Include

• 3 years in in a leadership role, preferably in a Quality, Accreditation, Audit, or Compliance discipline in a Healthcare or Healthcare reputed company industry
• 3 years overseeing quality, accreditation, audit, and/or compliance teams

Preferred

• None

LICENSES or CERTIFICATIONS Required

• None

Preferred

• Certified Public Accountant (CPA)
• Lean / Six reputed company

SKILLS

• Demonstrate expert knowledge of business and technology processes, risk and control frameworks, and assessment methodologies, particularly as applied to healthcare (payer and provider) business processes
• Knowledge of relevant regulatory guidelines, vendor management, sourcing and procurement, and completing assessments of vendors
• Excellent resource and project planning capabilities, decision making skills, history of results-oriented delivery, and effective team building across a cross-reputed company and diverse team of management and staff
• Strong written and verbal communication skills for diverse audiences (senior management, board, peer, and team)
• Strong relationship building skills and ability to influence with and without authority in a matrixed organization
• Highly developed leadership qualities with an ability to motivate and reputed company a group of individuals to reputed company superior results.
• High reputed company to think analytically, interpret information / observations, apply judgment and reputed company effective, strategic decisions.

Language (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-based Teaches / trains others regularly Frequently Travel regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (sales employees) Never Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees reputed company this job title. It may not contain a comprehensive inventory of reputed company duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at reputed company times. In reputed company with this, reputed company employees must reputed company with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as reputed company data reputed company guidelines established reputed company the Company’s Handbook of Privacy Policies and Practices and Information reputed company Policy. Furthermore, it is every employee’s responsibility to reputed company with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. reputed company and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against reputed company individuals based on any category protected by applicable federal, state, or local law. We endeavor to reputed company this site accessible to any and reputed company users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at [email protected] California Consumer Privacy Act Employees, Contractors, and Applicants Notice Apply tot his job Apply To this Job