About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You'll Have


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 NCQA 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.



What You'll Do

• Establish and maintain a comprehensive understanding of new and existing NCQA 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.




How You'll Do It

• 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.
• Performs additional responsibilities consistent with the scope and level of the role, as assigned.




Required Skills & Experience

• 5+ years of related medical care management professional experience.
• Bachelor’s degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.

Preferred Skills & Experience

• 5+ years of NCQA accreditation experience.
• Ability to communicate complex topics clearly and concisely, actively listen to anticipate stakeholder needs, and align others to drive informed decisions.
• Ability to analyze complex information, evaluate options, and work cross-functionally to drive resolution and prevent recurrence.
• Ability to leverage technology to communicate complex topics clearly and concisely, actively listen to anticipate stakeholder needs, analyze complex information, and align others to drive resolution.
• Ability to effectively organize work, balance competing priorities, and manage time across complex assignments and competing deadlines.
• Healthcare experience and/or knowledge of the managed care and health care/insurance industry.
• Experience with accreditation and/or compliance regulations for clinical programs.
• Experience managing complex/multiple projects simultaneously.
• Process improvement and ability to implement tools or systems that improve team efficiency and accuracy.
• Demonstrated experience with policy development, formal writing, and reporting.
• Ability to build and maintain relationships with internal and external stakeholders, clinicians, and others.
• Strong documentation and workflow process skills.
• Knowledge of medical terminology and procedures.
• Understanding of medical claims and coding.




Role Designation


Teleworker



Role designation definition:

• Teleworking is working full time remote.
• Hybrid is a minimum of 2 days onsite.
• Onsite is full-time onsite.




Compensation and Benefits


$90,800.00 - $120,300.00 - $149,800.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance

• Life insurance

• 401k

• Paid Time Off (PTO)

• Volunteer Paid Time Off (VPTO)

• And more

To discover more about what we have to offer, please review our benefits page.




Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

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

Physical requirements.