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Quality Mgmt Specialist Jobs

Company

Horizon Blue Cross Blue Shield of New Jersey
Address , Newark, 07105
Employment type FULL_TIME
Salary $93,000 - $127,050 a year
Expires 2023-10-16
Posted at 9 months ago
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:
  • Responsible for budgeting, cost containment and strategic planning of systemic enhancements to improve the quality and efficiency of project initiatives and yearly interventions.
  • Provide Consumer Assessment of Healthcare Providers and Systems (CAHPS) coaching to the Horizon providers community to improve the member experience.
  • Interacts with internal and external stakeholders to promote HCM&T clinical and operational improvement activities.
  • Proficient in Excel.
  • Interprets member experience performance through various sources of data.
  • 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.
  • Assist in the development of provider improvement action plans to improve member experience and improve CAHPS performance.
  • 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.
  • 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.
  • Measure performance goals of Medicare STAR Program plans and initiatives to ensure effectiveness of process. Report findings to management and stakeholders as appropriate.
  • Collaboratively serve as a HCM&T divisional resource with the Manager for health plan quality ratings.
Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.
Education/Experience:
  • Requires five (5) years professional business experience working in a health care environment.
  • Prefer five (5) years managed care experience.
  • Bachelor degree preferred or relevant experience in lieu of degree.

Knowledge:
  • Requires knowledge of healthcare management.
  • Requires knowledge of performance measurement and regulatory reporting
  • Requires working knowledge of PC and application software.
  • Requires knowledge of project management methodology.

Skills and Abilities:
  • Require excellent presentation skills.
  • Requires excellent verbal and written communications skills.
  • Requires comprehensive leadership and decision making ability.
  • Requires the ability to apply project management methodologies and practices across multiple projects.
  • Requires excellent analytical and problem solving 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:
  • Retirement Plans
  • Incentive Plans
  • Tuition Reimbursement
  • Generous PTO
  • Paid Volunteer Time Off
  • Wellness Programs
  • Comprehensive health benefits (Medical/Dental/Vision)
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.