About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.9 million members. We’re committed to reinventing health care to improve health for our members and the community. We hope you'll join us. Please note that effective 11/23/2021, all associates must be fully vaccinated for COVID19 unless legally entitled to a reasonable accommodation related to religious or medical exemptions.

How Is This Role Important to Our Work?

This position is responsible for working closely with leadership, leading cross-functional, cross-divisional teams, and partnering with external entities to achieve accreditation readiness, providing in-depth knowledge of accreditation requirements. The incumbent will provide business area consulting, assess organizational processes and policies, gather and annotate documents, provide feedback and evaluate progress, collect data and conduct analyses, and drive process improvement to achieve desired outcomes within tight deadlines. In addition, this position may participate in the coaching, mentoring, and training of other employees.

A Day in the Life:

• Establish and maintain a comprehensive understanding of new and existing accreditation standards, impacting multiple areas of the organization.
• Monitor, analyze and research requirements, obtain accreditation consulting support or policy decisions as needed to establish required business practices.
• Understand key relationships between accreditation standards and laws, regulations, and contract requirements.
• Establish and maintain relationships with business leaders and subject matter experts.
• Serve as a consultant and educator, providing guidance to multiple departments and stakeholders on accreditation requirements.
• Respond to business inquiries on accreditation matters.
• Collect, compile, analyze, interpret and annotate documentation for accreditation evidence, including support in preparing files for review.
• Identify and report on gaps and collaborate with business partners to ensure full compliance with accreditation standards.
• Prepare accreditation evidence in compliance with challenging deadlines to ensure timely document submission.
• Design methods to meet accreditation requirements and assist business leaders in evaluating and determining the best approach.
• Develop and/or contribute to policies, contract language, member and provider communications as required.
• Manage quality improvement processes including workgroup facilitation, survey design, data analysis, action planning, prioritization, performance monitoring and report writing for continuous improvement activities.
• Design, develop and use standardized templates and procedures in collaboration with team members and business partners to manage accreditation process and to create a comprehensive and proactive approach to the Quality Improvement Program and accreditation readiness.
• Maintain accurate and organized documentation.
• Support the Quality Improvement Program oversight committees, including contributing to agenda planning, committee presentations, accurate and comprehensive meeting minutes and follow up.
• Perform additional activities as required to support the accreditation process, the Quality Improvement Program, and/or quality department activities.

Nice to Have:

• Bachelors degree in business, health care, law, technology or other related field or equivalent additional years of experience.

• NCQA accreditation experience.
• Prior health plan experience.
• Clinical credential or background.

Required Skills and Experiences:

• 7+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.

• Prior health plan experience, or experience in compliance, audit, accreditation, quality improvement or other field requiring detailed analysis, critique or comparison.

• Excellent critical analysis skills.
• Detail orientation, with the ability to compare business practices against a set of detailed standards, evaluating compliance, recommending improvement strategies, and producing accurate records and documentation.
• Data analysis skills and experience.
• Proven ability to define problems, collect and analyze data, and transform into project-level strategies.
• Excellent continuous quality improvement and/or project management skills, with experience in team facilitation.
• Ability to deal with ambiguity and design and develop new structures and processes.
• Creative problem solving skills, adapting approach as needed.
• Demonstrated ability to work independently and make decisions as needed, with a track record of achievement.
• Organized and able to manage against challenging deadlines.
• Strong collaboration and relationship building skills, including the ability to work with a wide variety of people and personalities, and effectively facilitate group discussions and decision-making.
• Articulate communicator with excellent verbal and written communication skills and ability to create professional presentations and clearly present complex information.

Role Designation:

Teleworker

Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely.  Onsite is full-time onsite.

Make a difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to [email protected]

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.