Quality Management Specialist
Full Time
Hopewell, NJ
Posted
Job description
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
This position is responsible for supporting the Quality Management department with improvements through project planning, development and implementation, and the establishment of policies and procedures pertaining to regulations in both Government Programs and Commercial business.
Responsibilities:
- Develop project initiatives, process and performance measures for Quality Management and deliverables to ensure positive outcomes defined by corporate objectives and NCQA and regulatory regulations.
- Analyzes complex data and information to provide meaningful results, identifying success factors and improvement opportunities, recommending potential solutions to assist the business set strategic goals.
- Responsible for budgeting, cost containment and strategic planning of systemic enhancements to improve the quality and efficiency of project initiatives and yearly interventions.
- Collaboratively serve as a HCM&T divisional resource with the Manager for health plan quality ratings.
- Interacts with internal and external stakeholders to promote HCM&T clinical and operational improvement activities.
- Medicare Star Program:
- Measure performance goals of STAR plans and initiatives to ensure effectiveness of process. Report findings to management and stakeholders as appropriate.
- Reviews all HPMS and industry correspondence, related to Star Ratings in order to assist and remain current on all information and decision. Ensures that all information necessary for decision making is coordinated and any necessary documentation is prepared.
- CAHPS (Consumer Assessment of Healthcare Providers and Systems) :
- Provide CAHPS coaching to the Horizon providers community to improve the member experience. Interprets member experience performance through various sources of data. Assist in the development of provider improvement action plans to improve member experience and improve CAHPS performance.
The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.
Education/Experience:
- Prefers a Bachelors Degree in Health Management or related field or Masters degree in business, nursing, public health, health science, health economics, data systems, health promotion or related field. In lieu of degree, relevant work experience required.
- Requires five (5) years professional business experience working in a health care environment.
- Prefer five (5) years managed care experience.
Knowledge:
- Requires knowledge of project management methodology.
- Requires knowledge of healthcare management.
- Requires working knowledge of PC and application software.
- Requires knowledge of performance measurement and regulatory reporting
Skills and Abilities:
- Requires the ability to apply project management methodologies and practices across multiple projects.
- Requires comprehensive leadership and decision making ability.
- Requires excellent analytical and problem solving skills.
- Requires excellent verbal and written communications skills.
- Require excellent presentation skills.
Salary Range:
$93,000 - $127,050
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
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Comprehensive health benefits (Medical/Dental/Vision)
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Retirement Plans
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Generous PTO
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Incentive Plans
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Wellness Programs
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Paid Volunteer Time Off
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Tuition Reimbursement
Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.
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