Manager, Quality Improvement Data Analysis-Medicare STARS

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 

Oversight of quality data compilation, review and analysis process for quality management including data for HEDIS and Medicare Star. Serves as the primary liaison between vendors and enterprise in order to provide technical solutions for enterprise projects including NCQA accreditation and CMS Star programs. Develops business processes and leads staff to implement technology solutions to successfully monitor and improve technical data validity and integrity.

Responsibilities:

• Management of the Data Compilation from multiple sources to produce data for certification during audit and accreditation processes. 
• Facilitates daily tasks necessary to report Quality programs such as HEDIS and Medicare Star.
• Monitors data validity and data integrity for the QM processes which require identification of technical issues and correlation to accreditation and compliance standards. 
• Leads the relationship between HEDIS vendor and enterprise. 
• Facilitates daily tasks necessary to report quality programs such as HEDIS and Medicare Star. 
• Leads improvement for QM process by planning solutions based on data analysis and facilitating testing and implementation of vendor tools and processes.
• Leads planning for upcoming requirement changes for accreditation and compliance standards such as future requirements for exchange products. 
• Manage, direct, and develop staff by providing training, feedback and coaching.  Administer performance and salary review for staff.  Ensure staff meets all regulatory requirements and comprehends and complies with best practice methodology, professional standards, and internal policies and procedures.   Directs staff to ensure overall client satisfaction and appropriate level of service delivery.  
• Performs other duties as required by management.     

Education/Experience:   

• Bachelor's degree preferred or relevant work experience in lieu of degree.
• Requires 4 years of experience in data reporting or a related field
• Requires experience with effective/skillful project execution.   
• Requires demonstrated experience/ability to work on multiple assignments simultaneously.  
• Prefers minimum one year of supervisory experience.       
• Requires 4 years of SAS or SQL experience.
• SAS certification preferred.

Knowledge: 

• 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.
• Requires knowledge of health care systems and medical documentation. 
• Requires knowledge of NCQA and HEDIS. 
• Requires knowledge of CMS regulations and guidance.   
• Knowledge of Medicare Stars strongly preferred.

Skills and Abilities:  

• Demonstrates expertise in the understanding of business functions and technology necessary for quality data reporting. 
• Requires strong analytical skills and problem resolution skills. 
• Requires strong skills in multiple analysis tools and techniques.  
• Requires excellent communications skills. 
• Requires strong organizational skills.  
• Requires strong project execution skills. 
• Requires strong leadership skills.    

   

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:

$108,000 - $147,420

​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:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

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.

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.

Salary : $108,000 - $147,420