Manager, QI Data Analysis - Horizon Blue Cross Blue Shield of New Jersey

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.

Responsibility:

• 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 Degree preferred or relevant work experience required 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.
• Requires4+ years of SAS (strongly preferred) 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

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:

$106,400 - $145,215

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

Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

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.