This position can be located in Nashville, TN or Chattanooga, TN.
As the leader of BlueCross BlueShield of Tennessee’s Patient Quality Care Partnership (QCP) program, the Director of Operations is ultimately responsible for building, leading & managing BCBST’s newly formed, performance-based, physician quality program.
This person provides day-to-day management of the program and overall leadership for the QCP team responsible for ensuring its success. This person will work closely with the Patient-Centered Medical Home (PCMH) leadership to implement the physician quality program as a critical element BCBST’s PCMH support across the state. BCBST is the leading health plan in Tennessee, supporting the emergence of primary care-based patient centered medical homes, along with implementing physician quality improvement programs, and this leader is responsible for growing as well as improving this effort.
Initially, the Director of Operations will work with key clinical and operational leads to redefine the Quality Care Partnership. After this program evolution work, the team focus will then turn to roll out of the QCP within the footprint of existing PCMH’s as well as continued expansion of the program across BCBST’s primary care physician network. The overarching goal for this leader is to lead an operations-focused team responsible designing, developing, implementing and expanding BCBST’s physician quality program.
Both PCMH and QCP team leaders will be expected to report out on their progress against plan wide goals for practice growth and clinical quality improvements. Travel across Tennessee and working in regional offices, as well as private physician practices, is required.
Job Duties & Responsibilities
Responsible for working with both practice and health plan to ensure QCP program definition and implementation
Develop clinical measurement set and core workflows used to define and operationalize the QCP program
Convert existing P4P practices to the QCP program
Implement the QCP program in strategic primary care practices
Develop & secure bi-lateral execution of formal agreements in both converted and new practices
Recruit, hire, train team of regional supervisors responsible for supporting practice-embedded care coordinators
Lead the business assessment of a new population health management application partner
Provide senior relationship management to population health management application partner
Collaborate with clinical leadership to develop internal/external advisory committees offering QCP governance
Work closely with PCMH program to ensure smooth implementation of program, data collection, and reporting in support of performance-based payments
Assess, identify and prioritize QCP site needs and works to instill positive rapport and trust
Works directly with regional provider relations, nurse liaisons, medical directors, and internal BCBST operations to ensure successful and smooth operations
Responsible for overall performance of QCP sites via routine performance meetings, resource assessment, and all other data reporting needs related to QCP success
Maintain strong relationships with key administrative and physician leaders of BCBST provider group and QCP sites
Participate on work teams or project teams, as required for maintaining operations of the QCP
Work with BCBST project management on measurement and reporting tracking QCP progress
Provide leadership reports regarding program progress, including operational updates and annual program evaluations
Bachelor’s Degree in Business Administration or related field or equivalent work experience required
Clinical training and/or credentialing seen as positive
Masters of Business or advanced degree preferred
10+ years experience in the healthcare industry required
Minimum 5 years experience with data analytics, clinical measures (HEDIS, AQA, etc), clinical performance reporting required
Minimum 5 years leadership/managerial experience required
Experience with NCQA and other Quality programs (HEDIS, URAC, etc) preferred
Clinical practice experience a plus
Background experiences demonstrating both development & operations
Track record working w/ physicians and physician practice (clinical & administrative) staff
Strong intrapersonal skills leaning toward diplomacy
Enjoys leading and managing groups
High energy levels committed to clear written and spoken communication
Comfortable building clear connections to clinical initiative and their subsequent business affect
Analytic mindset: skilled at quantifying communicating results
Optimistic persistence; enjoys motivating people and teams
Intellectual curiosity: propensity towards learning and integrating learning into performance
Comfort dealing w/ highly fluid, ambiguous situations
Pre-disposition toward building vs. simply maintaining organizations
High intrinsic motivation/ Comfort working independently
Excellent computer skills with direct experience in MS Office, Word, PowerPoint, and Excel required
BlueCross BlueShield of Tennessee - 21 months ago
BlueCross BlueShield of Tennessee (BCBST) is the oldest and largest not-for-profit managed care provider in the state of Tennessee....