Healthcare Quality Analyst

Vaga não está no LinkedIn

🕒 Julho 28

🏖️ New Jersey – Remoto

🏖️ New Jersey – Remote

💵 $97.800 - $133.455 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

🧐 Analista

👻 Score fantasma 21%

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Horizon Connect @ Wall BCBSNJ

SiteLinkedInTodas as Vagas

2 - 10 funcionários

⚕️ Seguro de Saúde

🏥 Saúde

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ é uma presença no LinkedIn ou programa/escritório local associado ao Horizon Blue Cross Blue Shield de New Jersey (BCBSNJ). Com base no nome e no contexto, parece estar conectado às operações de seguro de saúde do Horizon BCBSNJ e ao alcance local ou envolvimento de membros/provedores na área de Wall, NJ. As informações disponíveis publicamente são limitadas e consistem principalmente na interface do site do LinkedIn em vez de um perfil da empresa, então essa descrição é conservadora e baseada na afiliação indicada pelo nome.

Descrição

• Responsible for supporting the Quality Management department with improvements through project planning, development and implementation, and the establishment of policies and procedures pertaining to regulations in both Government Programs and Commercial business • Analyzes complex data and information to provide meaningful results, identifying success factors and improvement opportunities, recommending potential solutions to assist the business set strategic goals • Measure performance goals of Medicare STAR Program plans and initiatives to ensure effectiveness of process • Report findings to management and stakeholders as appropriate • Reviews all HPMS and industry correspondence, related to Star Ratings in order to assist and remain current on all information and decision • Ensures that all information necessary for decision making is coordinated and any necessary documentation is prepared • Develop project initiatives, process and performance measures for Quality Management and deliverables to ensure positive outcomes defined by corporate objectives and NCQA and regulatory regulations • Responsible for budgeting, cost containment and strategic planning of systemic enhancements to improve the quality and efficiency of project initiatives and yearly interventions • Collaboratively serve as a HCM&T divisional resource with the Manager for health plan quality ratings • Interacts with internal and external stakeholders to promote HCM&T clinical and operational improvement activities • Provide Consumer Assessment of Healthcare Providers and Systems (CAHPS) coaching to the Horizon providers community to improve the member experience • Interprets member experience performance through various sources of data • Assist in the development of provider improvement action plans to improve member experience and improve CAHPS performance

🎯 Requisitos

• High School Diploma/GED required • Bachelor degree preferred or relevant experience in lieu of degree • Requires five (5) years professional business experience working in a health care environment • Prefer five (5) years managed care experience • Requires knowledge of project management methodology • Requires knowledge of healthcare management • Requires working knowledge of PC and application software • Requires knowledge of performance measurement and regulatory reporting • SAS Coding experience strongly preferred • HEDIS/Quality Initiative experience strongly preferred • State Reporting experience strongly preferred

🏖️ Benefícios

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement