This position is accountable for managing and overseeing the processes related to clinical quality performance data. Ensures collection of data for HEDIS, URAC, NCQA, focused audits, and special projects. Responds to quality improvement mandates and assists in the oversight and management of Quality Improvement initiatives in the provider service areas.
Directs staff to ensure overall client satisfaction and appropriate level of service delivery.
Develops and monitors goals for staff and provides ongoing feedback and coaching.
Conducts performance reviews on an annual basis and administers salaries for the staff.
Directs the employment activities of the office that include staffing, development, and training.
Ensures staff meets all regulatory requirements and comprehends and complies with best practices, professional standards, internal policies, and procedures.
Supports enterprise goal of improving quality of healthcare for customers by overseeing and managing the processes related to clinical quality performance data.
Oversees the clinical practice/preventative health guideline focused audits in coordination with the clinical and statistical teams.
Monitors external accreditation standards, conducts gap analysis, and develops action plans to address deficiencies.
Oversees departmental projects and programs related to HEDIS performance data measurement and reporting.
Develop and implement internal policies and procedures to support accreditation and data management.
Oversees day-to-day activities of Provider Quality Improvement Auditors ensuring flawless interactions with providers.
Supports Quality Improvement Program through development, implementation and monitoring of QI work plans.
Requires a Bachelor's degree from an accredited college or university, preferably in business administration, biological science, or related field.
Requires a minimum of four years business experience in healthcare, insurance or related field.
Requires a minimum of one to two years supervisory experience.
Requires knowledge of health care industry and managed care environment.
Requires knowledge of physician communities in the state of New Jersey.
Prefers knowledge of Horizon Blue Cross Blue Shield of New Jersey, products and services.
Behavioral Health experience/knowledge preferred.
Skills and Abilities:
Requires the ability to utilize a personal computer and applicable software.
Must have effective verbal and written communication skills and demonstrate the ability to work well within a team. Demonstrated ability to deliver highly technical information to less technical individuals.
Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.
Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities [or tasks], deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required. Demonstrated ability to work in a production focused environment.
Proven ability to exercise sound judgment and strong problem solving skills.
Proven ability to ask probing questions and obtain thorough and relevant information.
Must be client service focused with effective ability to empathize.
Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties.
Must be detail oriented with strong organizational and data processing skills. Proven ability to follow detailed instructions is essential, along with proven problem solving skills.
Proven analytical, research and problem solving skills a must.
Must demonstrate the ability to learn quickly and apply learning to new situations.
Demonstrated management experience with a focus on customer service, goal setting, and coaching. Exhibits proven leadership, delegation and project management skills.
Proven ability to influence without authority.
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.
Location: Newark, NJ
Activation Date: Wednesday, June 19, 2019
Expiration Date: Saturday, August 31, 2019
Horizon Blue Cross Blue Shield