Supervisor, Medicare Advantage Quality Operations - PGBA, LLC : Job Details

SummaryResponsible for leading Medicare Advantage team initiatives and project oversight including coordinating work efforts among the team and internal departments. Leads the day-to-day operations and responsible for reporting key metrics to management on a regular basis. Provides guidance for special training, data validation, project implementation and employee coaching. Meets with management team to review all active and planned work efforts and develop strategic plans based on team specialty. Schedules review sessions to obtain feedback from staff, troubleshoot issues and ensure that staff have adequate resources to complete assigned projects. Plans detailed projects and organizes concurrent initiatives through well-prepared staff training and resource alignment. Shifts resources as needed and manages project schedule to reach established goals.DescriptionPosition PurposeWe are currently hiring for a Supervisor Medicare Advantage Quality Operations, to join BlueCross BlueShield of South Carolina. In this role as a Supervisor Medicare Advantage Quality Operations, you will be responsible for leading Medicare Advantage team initiatives and project oversight including coordinating work efforts among the team and internal departments. Leading the day-to-day operations and responsible for reporting key metrics to management on a regular basis. Provide guidance for special training, data validation, project implementation and employee coaching. Meet with management team to review all active and planned work efforts and develop strategic plans based on team specialty. Schedule review sessions to obtain feedback from staff, troubleshoot issues and ensure that staff have adequate resources to complete assigned projects. Plan detailed projects and organizes concurrent initiatives through well-prepared staff training and resource alignment. Shift resources as needed and manages project schedule to reach established goals.Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.LogisticsLocation: This role is full time M-F 8am-5pm, hybrid (minimum 2 days a week onsite)What You Will Do:

• Responsible for recruiting and hiring, coaching and mentoring, monitoring and evaluation, and addressing all disciplinary issues in a timely manner
• Empowers employees for high engagement, job satisfaction, and corporate success. Arranges schedules, training resource plan based on team objectives and needs
• Establishes goals and timelines in partnership with management and disseminates information to team for successful deployment. Conducts meetings and organizes projects to achieve established goals
• Plans detailed projects, makes team assignments and oversees initiatives until completion
• Conducts and participates in functional area meetings related to current and upcoming activities, review active projects, assess team needs, and ensure the department is on schedule with initiatives
• Develops qualitative and quantitative reports to share with management for team progress
• May also give presentations or lead discussions among internal and external stakeholders
• Responsible for all team activities within specialty area and maintains relationships with internal and external stakeholders
• Acts as a subject matter expert and represents manager at both internal and external meetings
• Researches external vendor offerings, monitors vendor performance according to service level agreement and makes appropriate recommendations for the business
• Thinks proactively for business needs and maintains activities within budget
• Ensures data validation, team integrity and compliance for all activities according to CMS Medicare Advantage specifications
• Maintains appropriate documentation for all projects and audit materials
• May develop and conduct training or assessments for team members to ensure accuracy and consistency in performance
• Troubleshoots problems and elevates recommendations to management regarding any issues that may have a negative impact for Medicare Advantage performance

To Qualify for This Position, You Will Need:

• Required Education: Bachelors degree OR degree equivalency: 4 years job related work experience or Associate's and 2 years job related work experience
• Required work experience: 4 years of project administration, work coordination experience in a healthcare environment or similarly complex environment, including experience in a supervisory role or team lead role OR equivalent military experience in grade E4 or above
• Strong organizational, leadership, decision making, analytical, problem solving, interpersonal and project management skills
• Excellent verbal and written communication skills
• Ability to persuade, negotiate and influence
• Highly proficient PC skills
• Basic business math proficiency
• Analytical and critical thinking skills
• Basic knowledge of information systems environments and concepts
• Flexibility to adapt to changing business, client and project needs
• Ability to balance workload for several work requests simultaneously
• Basic understanding of resource planning and organizational impacts
• Required software tools: Microsoft office

What We Prefer:

• Strong HEDIS experience
• Experience educating providers on quality metrics
• Registered Nurse

What We Can Do for You:

• 401(k) retirement savings plan with company match
• Subsidized health plans and free vision coverage
• Life insurance
• Paid annual leave - the longer you work here, the more you earn
• Nine paid holidays
• On-site cafeterias and fitness centers in major locations
• Wellness programs and healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Incentive Plan
• Merit Plan
• Continuing education funds for additional certifications and certification renewal

What to Expect Next:After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required notifications. Here's more information. Equal Employment Opportunity StatementBlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-###-####, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.