Quality Management Analyst

Pay Range:

$73,500.00 - $110,300.00

Please email [email protected] if you are a candidate seeking a reasonable accommodation for the application and/or interview process.

At BCBSRI, our greatest resource is our people.

We come from varying backgrounds, different cultures, and unique experiences. We are hard-working, caring, and creative individuals who collaborate, support one another, and grow together. Passion, empathy, and understanding are at the forefront of everything we do—not just for our members, but for our employees as well.

We recognize that to do your best work, you have to be your best self.

It’s why we offer flexible work arrangements that include remote and hybrid opportunities and paid time off. We provide tuition reimbursement and assist with student-loan repayment. We offer health, dental, and vision insurance as well as programs that support your mental health and well-being. We pay competitively, offer bonuses and investment plans, and are committed to growing and developing our employees.

Our culture is one of belonging.

We strive to be transparent and accountable. We believe in equipping our associates with the knowledge and resources they need to be successful. No matter where you’re at in the organization, you’re an integral part of our team and your input, thoughts, and ideas are valued.

Join Others Who Value a Workplace For All.

We appreciate and celebrate everything that makes us unique, from personal characteristics to past experiences. Our different perspectives strengthen us as an organization and help us better serve all Rhode Islanders.

We’re dedicated to serving Rhode Islanders.

Our focus extends beyond providing access to high-quality, affordable, and equitable care. To further improve the health and well-being of our fellow Rhode Islanders, we regularly roll up our sleeves and get to work (literally) in communities all across the state—building homes, working in food pantries, revitalizing community centers, and transforming outdoor spaces for children and adults. Because we believe it is our collective responsibility to uplift our fellow Rhode Islanders when and where we can, our associates receive additional paid time to volunteer.

Why This Job Matters:

Identify quality issues through analysis of data and evaluation of clinical or business processes. Facilitate the design, implementation, and maintenance of quality initiatives that improve operational business processes or member healthcare and safety. Partner and collaborate with provider network to improve performance, collaboration, and stakeholder relationships.

What You’ll Need To Succeed:

• Identify clinical quality issues and business process improvement opportunities through data analysis and internal process evaluation. Conduct root cause analyses and develop interventions to enhance clinical or business processes.
• Analyze, develop, execute, and manage the PCP Quality Incentive Program to ensure alignment with business goals and industry standards
• Serve as a resource to internal and external stakeholders, supporting the application of quality management principles and fostering a culture of continuous quality improvement. Become a subject matter expert on incentive programs, HEDIS measures, CMS Star Rating Program, and quality best practices.
• Collaborate and manage the collection of quality data from provider partners to ensure accuracy and completeness, driving performance improvement and meeting organizational goals.
• Develop, enhance, and manage provider quality education materials.
• Prepare documentation, data, presentations, and reports for management, external partners, and quality oversight committees.
• Conduct provider site visits as needed to support providers and practices on quality, incentive programs, coding, medical record collection, etc
• Utilize various data and information systems supporting these activities. Work with technical staff on maintenance of data, and the utilization of various IT systems to maximize the clinical and business benefits of effective information management.
• Develop and implement educational programs for new and existing employees in the division to increase knowledge and skill development in areas including, but not limited to, quality management principles, model and tools, change management.
• Participate in department initiatives and projects.
• Perform other duties as assigned.
  
  

What You’ll Need To Succeed:

• Bachelor’s degree in Nursing, Health Administration, Business, or related field, or an equivalent combination of education and experience
• Three to five years experience in clinical quality activities or experience in business process improvement activities
• Active and unrestricted RN license issued by a state participating in the Nurse Licensure Compact (NLC)
• Knowledge of clinical quality management principles or business process improvement techniques
• Facilitation skills
• Understanding of medical terminology
• Knowledge of regulatory and accrediting standards including, but not limited to NCQA, URAC, DOH, DHS, CMS
• Advanced analytical skills, with the ability to interpret and synthesize complex data sets
• Good business acumen and political savvy
• Knowledge of business process improvement techniques and strategies
• Excellent verbal and written communications skills
• Negotiation skills
• Presentation skills
• Decision-making skills
• Good problem-solving skills
• Ability to interface with employees at all levels
• Ability to effectively navigate ambiguous situations with limited direction
• Excellent organizational skills and ability to successfully prioritize multiple tasks
• Ability to handle multiple priorities/projects
  
  

The Extras:

• Certified Professional in Healthcare Quality (CPHQ) designation or equivalent certification
• Experience in program development and quality improvement
• Experience with HEDIS, NCQA, and CMS
  
  

Location:

BCBSRI Is Headquartered In Downtown Providence, Conveniently Located Near The Train Station And Bus Terminal. We Actively Support Associate Well-being And Work/life Balance And Offer The Following Schedules, Based On Role:

• In-office: onsite 5 days per week
• Hybrid: onsite 2-4 days per week
• Remote: onsite 0-1 days per week. Permitted to reside in the following states, pending approval from the Human Resources Department: Arizona, Connecticut, Florida, Georgia, Louisiana, Massachusetts, North Carolina, Oklahoma, Rhode Island, South Carolina, Texas, Virginia
  
  

Our culture of belonging at Blue Cross & Blue Shield of Rhode Island (BCBSRI) is at the core of all we do, and it strengthens our ability to meet the challenges of today’s healthcare industry. BCBSRI is an equal opportunity employer.

The law requires an employer to post notices describing the Federal laws. Please visit  www.eeoc.gov/know-your-rights-workplace-discrimination-illegal to view the "Know Your Rights" poster.