Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
This position is responsible for leading the design, implementation, and monitoring of all HEDIS member and provider interventions. This position is also responsible to operationalize initiatives to improve our HEDIS performance by working with both internal and external stakeholders and will serve as the liaison to all external vendors.
- Responsible for leading the design, implementation and monitoring of all outreach and interventions.
- Acts as the main contact for vendors and responsible for vendor management including implementation support, data management, ongoing performance monitoring, monthly accruals and addressing operational issues.
- Provides oversight of key initiatives/Intervention and reports intervention Success Metrics to management.
- Leads the Impact analysis of all Interventions providing end to end support from gathering data, Providing requirements to data team and summarizing results for effective monitoring of HEDIS Interventions and to support strategic planning of HEDIS activities and meet NCQA requirements.
- Analyzes data and information to provide meaningful results, identifying success factors and improvement opportunities, recommending potential solutions to assist the business set strategic goals.
- Interacts with internal and external stakeholders to promote H&NS clinical and operational improvement activities.
- Lead or participate in meetings and presentations with internal and external audiences.
- Works on other Projects and ad hoc reports as assigned
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:
- Bachelor’s degree preferred or relevant work experience in lieu of degree.
- Requires 5-7 years experience in a healthcare setting: health plan, hospital, physician practice, or managed care organization
- Experience and understanding of NCQA, HEDIS, or URAQ standards.
Knowledge:
- Requires knowledge of health care delivery systems, distribution channels, health care industry and health insurance industry. Knowledge of applicable laws and regulations as well as of Governmental Agencies and Regulatory.
- Requires knowledge of HEDIS, CAHPS, and Stars for CMS.
- Knowledge of quality improvement methodology.
- Knowledge of Project management methodology
Skills and Abilities:
- Effective verbal and written communication skills
- Project management
- Effective time management and ability to manage multiple priorities or tasks
- Problem solving skills
- Function as self starter
- Detailed Oriented
Travel %:
10%
Salary Range:
$76,800 - $102,795
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.
What We Do
Horizon Blue Cross Blue Shield of New Jersey- the state’s largest and oldest health insurer - is a subsidiary of Horizon Mutual Holdings, Inc., a not-for-profit mutual holding company.
Together with its affiliates, Horizon provides a wide array of medical, dental, vision and prescription insurance products and services. As New Jersey’ health solutions leader, Horizon is transforming healthcare by working with doctors and hospitals to deliver innovative, patient-centered programs that improve quality and lower costs. It is headquartered in Newark, NJ with offices in Wall and Hopewell, NJ.
Horizon serves 3.7 million members including more than 1 million who rely on Medicaid for their health coverage.
