Clinical Support Supervisor - HEDIS (Hybrid)

Resp & Qualifications

PURPOSE:
In this role, the focus will be supporting the annual Hybrid HEDIS Project, Audits, year around Quality Improvements and Initiatives.
Supervises and provides daily direction to multifunctional team members regarding staff scheduling, training, and development; audits; policies, procedures, and work production quantity and quality. Functional areas may include but not limited to clinical support, operations and services related to health care providers and/or members and families.
This position is vital in driving our commitment to quality and excellence, ensuring our services align with the highest standards and contribute positively to our HealthPlan ratings.

ESSENTIAL FUNCTIONS:

• Supervises employee outcomes by training, assigning, scheduling, coaching, and counseling employees; communicating job expectations; planning, monitoring, and appraising job contributions; conducting and overseeing audits; and ensuring adherence to policies, procedures and regulations.
• Meets operational standards by contributing information to strategic plans and reviews; implementing production, productivity, quality, and customer-service related standards; resolving people/process/technical problems; identifying system and/or process and workflow improvements. Supports the development of program descriptions, workflows, job aids and other SOPs related to non-clinical support teams and their activities.
• Maintains departmental objectives by monitoring daily operations; resolving any issues that require manual review or technical support. Consistently supervises day to day clinical support operations and makes necessary adjustments where needed, including resources/staffing. Researches and resolves escalated cases, emails or telephone calls, review and resolves complex issues that have not been resolved by staff.
• Maintains and improves clinical support operations by monitoring departmental and system performance; identifying and resolving problems; supervising process improvement and quality assurance programs; and supervises the process of conducting and following up on internal or external audits.
• Prepares performance reports by collecting, analyzing, and summarizing data and trends.
• Collaborates with health care providers, community resource partners, and internal clinical and non-clinical colleagues to ensure effective service delivery and integration of member focused activities incorporating Quality Improvements and Initiatives into various functional areas.

SUPERVISORY RESPONSIBILITY:
This position manages people

QUALIFICATIONS:

Education Level: Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Licenses/Certifications:

• An active RN/LPN, RHIT/RHIA or other clinical License/Certification.

Experience: 3 years related professional experience with demonstrated leadership skills and Hybrid HEDIS Project Experience (Medical Record Retrieval, Abstraction and Overreading).
Must have proficiency in clinical support and/or member and health care provider outreach activities.

Preferred Qualifications:

• Proficiency in State or local regulations and/or compliance requirements related to healthcare delivery 5 years of recent HEDIS, Quality and NCQA Experience within the last 8 years.

Knowledge, Skills and Abilities (KSAs)

• Knowledge and experience in care coordination, clinical support, utilization view and/or member outreach operations.
• Advanced Ability to mentor and coach associates to accomplish goals, provide objective evaluation of associate performance, and implement strategies to improve individual and team-based performance as needed.
• Highly proficient in Microsoft Office programs including Word, Excel, and Power Point. Proficient in the use of web based electronic medical record or customer service systems.
• Excellent communication skills both written and verbal. Ability to positively influence other demonstrating respect and compassion. Strong presentation skills.
• Ability to plan, prioritize and organize work to meet changing priorities. Experienced with making decisions regarding work processes based on established guidelines.
• Proficient in Demonstration of critical and innovating thinking, as well as change leadership. Proficient to Compile, analyze, and organize data and information from multiple sources to carry out assignments and inform leadership on operational performance.
• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $62,280 - $128,453

Travel Requirements:
Estimate Amount: 10%

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Quality and Accreditation

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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