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Quality Program Manager (Accreditation/Regulatory)-004153 - Rochester



Services Financiers


293 jours | Rochester, New York, United States | Excellus BCBS

Quality Program Manager (Accreditation/Regulatory)-004153 - Rochester

293 jours | Rochester, New York, United States | Excellus BCBS

Excellus BCBS

Date de début :avril 09

Appliquer avant :mai 09 2021

Industrie : Santé, Services Financiers, Assurances,

Type :Temps plein

Niveau d'ancienneté : 3-5 ans

Description du poste

Under the guidance of the Director, the Program Manager manages related complex programs/projects as well as provides higher level operational and technical solutioning that reflects a more holistic or end-to-end approach to quality performance, i.e. accreditation, regulatory (CMS/DOH), member experience and health plan performance.

This position is an integral part of the team serving as the primary contact to internal and external stakeholders in all matters related to Program.The Program Manager provides leadership and direction to ensure the Program submissions are delivered according to specifications and deadlines along with ongoing monitoring of results.Duties include coordinating roadmap/work plan preparation, coordinating with staff to drive compliance activities, accuracy, evidence collection, reporting, and interacting with external regulators/accreditors. This individual is responsible for all aspects of accreditation management in collaboration with other key departments and external vendors from initiation to monitoring and maintenance. In addition, conducts operational process analysis and process improvement identification and recommendations and executes action plans.

This position requires working in partnership with all levels of management and staff across various operational groups. This role is an individual contributor but requires strategic thinking, planning and management of complex work at a high level so issues are anticipated, prevented and organizational enhancements/modifications are made to increase our rating programs through improved member experience.

Essential Responsibilities/Accountabilities

  • Performs elevated project management duties; specifically, provides focus on measures/outcomes and operational optimization/efficiencies, manages multiple projects, manages change in business strategies and priorities, and maintains an organizational / enterprise lens to all activities.
  • Manages day-to-day operations to assess the organizations compliance with Program standards.
  • Communicates effectively with users/customers, colleagues, sponsors, project teams and across a range of disciplines, and all levels of management to review project scope/progress and resolve project issues/barriers, as often as necessary to ensure timely completion of the project.
  • Plans, schedules, monitors, and reports on activities related to the project. Creates and makes formal presentations of trending reports throughout Program cycle to keep executive management apprised of current status and completion.
  • Provides project leadership to develop project plan, monitors progress and timeliness to ensure deadlines are met.
  • Acts independently to assess and monitor projects, including managing scope, problem identification, developing potential solutions, implementing them and evaluating outcomes involving various staff as needed. Responsible for troubleshooting and using all resources to find needed answers. This includes assessing when to elevate issues and doing so as needed
  • In collaboration with Quality Measurement, develops, maintains progress reports (dashboards) to determine impact of interventions relative to goals, evidence compliance and status of program.
  • Act as an ambassador for quality accreditation and socialize organizational importance and awareness for the program
  • Build strong collaborative relationships with project managers, divisional and cross functional leads through-out the organization on multiple levels.
  • Serves as primary contact for external and internal inquires related to Program. Manages applicable vendor/auditor/regulator relationships, inclusive of calls, site visits, audits, consultants and preparation of staff.
  • Coordinates collection and submission of evidence required to meet program requirements and assesses compliance.
  • Oversees development, contracting process, implementation and compliance of delegation/vendor agreements related to Program. In collaboration with business areas, define content, oversight activities, and reporting. Monitors agreements to ensure compliance is maintained.
  • Provides governance and oversight to Project team rooms, artifacts and schedules.
  • Organize, coordinate and facilitate regular project reviews/meetings with other team members and cross functional stakeholders to foster coordination and communication. Provides oversight to ensure consistency in approach.
  • Plans, directs, and coordinates matrixed team(s) activities to manage and implement interrelated projects/activities from contract/proposal initiation to final operational stage.
  • Determines, monitors, and reviews all project economics to include project costs, operational budgets, staffing requirements, project resources, and project risk.
  • Formulates contingency plans to address schedule revisions, manpower adjustments, fund allocations, and work requirements.
  • Controls project requirements, scope, and change management issues.
  • Facilitates Management communication; focusing on critical path issues, risks and mitigation approaches.
  • Selects and applies appropriate tools to accurately estimate and plan the work of teams or project groups within agreed policies.Produces work plans according to required standards.Works with colleagues to produce/recommend/develop short term and long-term plans.
  • Establishes appropriate metrics for measuring key project criteria; monitors results to those metrics.
  • Maintains currency on emerging technologies, project management techniques, regulatory/accreditation requirements. Attend classes, training seminars, and conferences relevant to Program. Provide training and guidance to staff. Implement plans to incorporate new requirements into all impacted regions of the Corporation.
  • Provides education, assistance and coaching to staff involved in quality improvement (QI) and accreditation activities using the latest quality improvement methods, measurement, analysis and performance tracking.Trains and mentors’ stakeholders on accreditation and regulatory requirements.
  • Coaches and counsels’ members of cross-functional teams to accomplish activities, meet established schedules, or resolve technical/operational issues.
  • Monitors and evaluates quality of performance and product from all work within scope of responsibility.
  • Fosters an environment of continuous improvement.Constantly exploring ways to increase efficiencies and productivity, reducing waste, and reducing costs.
  • Acts independently to assess and monitor projects, including managing scope, problem identification, developing potential solutions, implementing them and evaluating outcomes involving various staff as needed. Responsible for troubleshooting and using all resources to find needed answers. This includes assessing when to elevate issues and doing so as needed
  • Performs vendor management activities for AQRP area as well as provide vendor oversight coordination for larger Healthcare Improvement team
  • Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies’ mission and values, adhering to the Corporate Code of Conduct, and leading to the Lifetime Way values and beliefs.
  • Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
  • Regular and reliable attendance is expected and required.
  • Performs other functions as assigned by management.

Minimum Qualifications

  • A Bachelor’s degree in Nursing, Business or Healthcare Administration, Analytics, Project Management, or related fields with a minimum of 5 years of related work experience. In lieu of degree, a minimum of 7 years of related work experience
  • A minimum of 3 years of project management. PMI/PMP certification preferred
  • Applied knowledge of quality improvement, accreditation and regulatory compliance
  • Demonstrated leadership skills, quality principles, proficiency in problem solving and quality tools/techniques
  • Demonstrated skills in forming and fostering high performance, cross-functional teams.
  • Strong communication skills required, including ability to effectively communicate verbally and in writing, internally and externally, and across the organization.
  • Strong facilitation skills.
  • Communicates effectively with users/customers, and colleagues across a range of disciplines, and all levels of management.
  • Strong understanding and application of vendor management skills.
  • Very strong analytical and business process development skills.
  • Demonstrated success in working in a fast-paced environment
  • Demonstrated competence in staff leadership and project leadership tasks.
  • In-depth knowledge of application delivery, management structures, and reporting procedures.
  • Demonstrated experience in integrating enterprise applications.
  • Demonstrated experience managing teams executing under multi-phased and multi-deployment project schedules
  • Demonstrated experience communicating with senior management in various formats, informal discussions, written reports, scheduled meetings and executive level presentations
  • Knowledge and experience working in the healthcare, health insurance or similar industry

Physical Requirements

  • Spends majority of the day working from a desk

The Lifetime Healthcare Companies aims to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.

Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services.With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.

Our Company Culture

Employees are united by our Lifetime Way Values & Behaviors that include compassion, pride, excellence, innovation and having fun!We aim to be an employer of choice by valuing workforce diversity, innovative thinking, employee development, and by offering competitive compensation and benefits.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.

Equal Opportunity Employer







Bachelors or better in Bach Business Admin.

Bachelors or better in Bach Nursing.

Bachelors or better in Healthcare Administration.


Licenses & Certifications


PMI Certification

PMP Certification

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities

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