Oversight Analyst
Blue Cross Blue Shield of Rhode Island (Providence, Rhode Island)

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Oversee corporate compliance with National Committee for Quality Assurance (NCQA), as well as ensuring compliance for any delegated vendor that performs a function that BCBSRI would ordinarily perform. REPRESENTATIVE JOB DUTIES: Monitor and track organizational and delegate compliance with NCQA requirements. Oversee BCBSRI operations to ensure processes are in place to meet or exceed standards. Conduct ongoing reviews of applicable policies, procedures, internal departmental auditing, and coaching to ensure an understanding of NCQA standards and preserve the plan’s accountability and accreditation status. Assist with preassessment evaluation, focused and annual reviews and assessments of reporting requirements to meet NCQA standards. Ensure functional departments understand their respective roles and assist departments in the development of review tools. Adhere to project timetables. Documentation collection and verification to validate internal and external compliance with NCQA. Produce comprehensive review materials in preparation for organizational reviews. Develop and assist in the oversight of quality improvement activities to ensure compliance. Identify barriers and problems and assist in solving problems related to internal compliance. Facilitate interdepartmental communication regarding accreditation standards and requirements by attending appropriate work groups and meetings as needed. KNOWLEDGE, SKILLS & ABILITIES REQUIRED: Knowledge of: Managed care health plans, including primary care physician models, benefits, network use, system and overall claims, customer service, membership enrollment, finance, utilization review, provider relations/credentialing, quality improvement and their interdependencies. Technical Skills: Proficiency in PC based word processing, graphics and spreadsheet applications Strong verbal and written communication skills. Strong project management skills Negotiation skills Interpersonal skills Ability to: Demonstrated ability to apply critical thinking and logic in the identification of core problem issue and resolution. Work in a fast paced environment and manage complex and time-sensitive work To meet deadlines. Work independently as well as on a team. Handle multiple priorities. Exercise sound judgment. Take initiative in finding solutions to difficult and/or sensitive problems. Perform other duties as assigned. QUALIFICATIONS: Minimum Education and Experience: Bachelor’s degree in nursing, health administration or related field or an applicable combination of education and experience. 5-8 years of progressive managed health care plan operations experience Experience in project management or program development, including; defining clear goals/objectives; developing resource requirements, developing and monitoring detailed project and task work plans, completing project/program assignments on time, on budget and providing goals and objective were met. Preferred Education, Additional Qualifications and Experience: NCQA or other health care plan or facility accreditation experience preferred. BCBSRI values diversity and is an equal opportunity/affirmative action employer m/f/d/v. -see job description