Ourhrconnect

Quality and Risk Performance Officer, Medicare Advantage

Columbia, South Carolina · Contract

Sponsorship not specifiedDetected 5 days ago

ExcelLeadershipCommunicationMicrosoft Office

About the role

Summary Why should you join the BlueCross BlueShield of South Carolina family of companies?
We operate one of the most sophisticated data processing centers in the Southeast.
If you are dedicated to the same philosophy, consider joining our team!

Develop and implement strategic plans to improve the Stars ratings for Medicare Advantage programs.
Build relationships with, and lead, cross-functional teams to drive Stars rating initiatives and best practices by promoting innovation, strategy development, and implementation excellence.
Develop reports for senior leaders and internal stakeholders. Present findings of improvement efforts, ongoing performance measures, and recommended actions plans.
Build and maintain effective relationships with providers and vendors.
Ability to develop and lead high performing team.
Ability to build effective relationships with cross-functional teams and external stakeholders.
Effectively manage vendors and hold them accountable for high performance.

Bachelor's degree.
3 years of management experience OR 3 years of equivalent military experience in grade E4 or above;
3 years of Medicare Advantage Stars Rating program experience.
Ability to work across all levels of the organization, including work with individual contributors, executive and management audiences, physicians and vendors.

As the Medicare Advantage Quality and Risk Performance Officer, you will work closely with the leadership team to oversee all related activities for Star rating improvement functions.
The Officer should also be able to clearly articulate solutions, challenges, and results to executives in a professional and formal style.
The ideal candidate will have a strong understanding of HCC coding, RAF score optimization, and CMS regulatory requirements, with a proven ability to translate data insights into actionable strategies.
include leading risk adjustment initiatives, supporting audit readiness (e.g., RADV), and identifying opportunities to enhance coding capture and care gap closure.
Experience working with value-based arrangements, including shared savings models and provider incentive programs, is highly preferred.

Microsoft Office suite, including advanced PowerPoint and Excel skills
Ability to effectively lead organization wide initiatives.
Excellent communication and interpersonal skills.
Ability to set priorities, meet objectives for complex projects involving multiple stakeholders, and execute according to plan.
Master's degree or RN.
HEDIS experience.
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)

As an innovative thought leader, you must diagnose performance gaps to define organizational strategy and craft annual and long-term plans for improvement.

Develop and implement strategies to engage, education, and motivate providers.
Drive positive culture transformation and corporate-wide awareness of Stars through education, communication, and employee engagement.
Develop and refine internal education.
Required Education: Bachelor's degree.
10 years of experience in insurance, healthcare, or similarly complex industry
Concurrent experience includes: 5 years of health plan experience;
Stars leadership position in a high performing (4+ Stars) Medicare Advantage health plan.

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status.
Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans.
It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

This listing is sourced directly from Ourhrconnect's careers page and normalized into a canonical job model.