Quality Improvement Program Manager

Blue Cross of Idaho; Meridian (ID); On-site; USD 78,000 - 117,000; Full time

Benefits offered by this job

Paid time off and holidays

Medical/dental/vision/pharmacy保险

401(k) matching

Education reimbursement

Life insurance

Job summary

Blue Cross of Idaho is seeking a Healthcare Operations professional to support quality and clinical improvement across product lines. The role involves cross-functional program coordination, vendor partnerships, and contracting activities to drive improvements and outcomes.

You will organize workgroups, coordinate vendor relationships, and monitor program performance, with a focus on HEDIS improvements and operational efficiency. A bachelor’s degree or equivalent experience is required.

Qualifications

• 5 years’ healthcare field or relevant experience.
• Education: Bachelor’s Degree or equivalent work experience (Two years’ relevant work experience is equivalent to one-year college).

Responsibilities

• Collaborate with cross-functional teams, vendors, and business partners to organize efforts and workgroups targeted at quality improvement, member outreach, provider support, clinical improvement, and related program activities.
• Coordinate vendor and contracting activities supporting quality programs, including gathering business requirements, supporting requests for proposals or services, contract renewals and amendments, and implementation of approved services in partnership with Procurement and other internal stakeholders.
• Support ongoing management of quality vendors by monitoring contractual deliverables, service commitments, timelines, issues, and program performance, and coordinating appropriate follow-up with internal and external stakeholders.
• Identify, prioritize, sequence, and recommend initiatives for HEDIS measure improvement for each line of business. Maximize the opportunity for improvement while taking into consideration cost, benefit, available resources, and return on investment.
• Identify opportunities for quality and operational improvement using annual, prospective, vendor, and program data sources.
• Coordinate implementation of approved quality initiatives and vendor-supported programs, including workplans, timelines, business requirements, stakeholder coordination, and issue resolution.
• Track program, project, and vendor outcomes and present conclusions, risks, recommendations, and opportunities to leadership.
• Support departmental planning and oversight of vendor services, including contract requirements, renewals, invoices, budgets, and anticipated program needs.
• Coordinate and support cross-functional efforts to develop and implement improvement plans and operational solutions for all applicable lines of business.
• Present program results, analysis, status, risks, and recommendations to management, steering committees, vendors, and impacted work teams.
• Ensure documentation of improvement plans, vendor activities, contractual deliverables, decisions, and program outcomes.
• Perform other duties and responsibilities as assigned.

Skills

Healthcare experience

Education

Bachelor's degree or equivalent

Job description

Join Blue Cross of Idaho’s growing Healthcare Operations team! This role will support quality and clinical improvement efforts for all product lines through cross-functional program coordination, vendor partnerships, and contracting activities. Organize and support workgroups and external partnerships to effect changes needed for improvement.

What we are looking for:

5 years’ healthcare field or relevant experience

Education: Bachelor’s Degree or equivalent work experience (Two years’ relevant work experience is equivalent to one-year college)

What your day may look like:

• Collaborate with cross-functional teams, vendors, and business partners to organize efforts and workgroups targeted at quality improvement, member outreach, provider support, clinical improvement, and related program activities.
• Coordinate vendor and contracting activities supporting quality programs, including gathering business requirements, supporting requests for proposals or services, contract renewals and amendments, and implementation of approved services in partnership with Procurement and other internal stakeholders.
• Support ongoing management of quality vendors by monitoring contractual deliverables, service commitments, timelines, issues, and program performance, and coordinating appropriate follow-up with internal and external stakeholders.
• Identify, prioritize, sequence, and recommend initiatives for HEDIS measure improvement for each line of business. Maximize the opportunity for improvement while taking into consideration cost, benefit, available resources, and return on investment.
• Identify opportunities for quality and operational improvement using annual, prospective, vendor, and program data sources.
• Coordinate implementation of approved quality initiatives and vendor-supported programs, including workplans, timelines, business requirements, stakeholder coordination, and issue resolution.
• Track program, project, and vendor outcomes and present conclusions, risks, recommendations, and opportunities to leadership.
• Support departmental planning and oversight of vendor services, including contract requirements, renewals, invoices, budgets, and anticipated program needs.
• Coordinate and support cross-functional efforts to develop and implement improvement plans and operational solutions for all applicable lines of business.
• Present program results, analysis, status, risks, and recommendations to management, steering committees, vendors, and impacted work teams.
• Ensure documentation of improvement plans, vendor activities, contractual deliverables, decisions, and program outcomes.
• Perform other duties and responsibilities as assigned.

As of the date of this posting, a good faith estimate of the current pay range : $78,064 - $117,095. The position is eligible for an annual incentive bonus (variable depending on company and employee performance).

The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, travel requirements, internal equity, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.

We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.

We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.

Reasonable accommodations

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.