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Clinical Quality Improvement Liaison

Company

Horizon Blue Cross Blue Shield of New Jersey
Address , Newark, 07105, Nj
Employment type FULL_TIME
Salary $75,300 - $100,800 a year
Expires 2023-06-27
Posted at 1 year ago
Job Description
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
The Clinical Quality Improvement Liaison is responsible for managing HEDIS and Stars performance by working with low performing providers to identify areas of opportunity. The CQA will be the main Quality contact for providers, they will provide guidance and resources in order for the provider to achieve target Quality Performance metrics, as established by the National Committee for Quality Assurance.
Responsibilities:
  • Collaborate with Value Based Programs and Provider Contracting and Services to manage provider quality performance.
  • Primary liaison for the Quality Management department and all assigned provider groups to improve HEDIS and Stars Quality Performance.
  • Provide HEDIS provider guidelines that highlight appropriate HEDIS codes for claims submission.
  • Monitor and analyze provider Quality Performance Reports. Identify areas of improvement, provide assistance with root cause analysis, assists with developing solutions, and develop a work plan to monitor progress.
  • Conduct on-site visits on a regular basis to implement the work plan and to conduct provider education sessions regarding appropriate coding practices and chart documentation.
  • Assists in the development of member and provider outreach, engagement, and education materials to improve Quality Performance.
  • Completes other assigned functions, including special projects, as requested by management.
  • Aggregate monthly project performance metrics
  • During HEDIS season, assists with the retrieval of charts, chart abstraction, and chart review entries. CQM must adhere to the HEDIS guidelines for chart review abstractions and standards.
  • Creates and updates processes, work plans and policies.
  • Conducts training for new and current staff on processes that will result in improving HEDIS and Stars Quality 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 experience in continuous quality improvement and/or quality management.
  • Requires a minimum of three (3) years experience in a healthcare setting: health plan, hospital, physician practice, or managed care organization
  • Requires Bachelor's degree from an accredited college or university, preferably in Healthcare or related field. In lieu of degree applicant must have an additional 3 years of equivalent and relevant work experience.

Additional licensing, certifications, registrations:
  • No Regulatory Requirement; Active Unrestricted NJ Clinical License Preferred

Knowledge:
  • Prefers Project Management skills.
  • Prefers knowledge of Population Health Management and Preventative Management Programs
  • Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Microsoft Outlook. Should be knowledgeable in the use of intranet and internet applications.

Skills and Abilities:
  • Interpersonal & Client Relationship
  • Requires excellent verbal and written communication skills.
  • Analytical & Problem Solving
  • Process Management
  • Information & Knowledge Sharing
  • Presentation Skills
  • Continuous Improvement

Travel % (If Applicable):
  • 30% Travel to Provider Offices
Salary Range:
$75,300 - $100,800
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:
  • Wellness Programs
  • Tuition Reimbursement
  • Paid Volunteer Time Off
  • Incentive Plans
  • Comprehensive health benefits (Medical/Dental/Vision)
  • Generous PTO
  • Retirement Plans
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.