Manager, Quality Improvement Data Analysis-Medicare Stars

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

Job Summary:

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 Med 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.     

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 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.    

   

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

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