Quality Management Specialist

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🕒 May 26

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $97.8k - $133.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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NJM Insurance Group

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1913

Insurance

NJM Insurance Group is a well-established insurance provider offering a range of personal and commercial insurance products. Their services include auto, homeowners, renters, condo, commercial auto, and business insurance, with a focus on exceptional customer satisfaction and claims experience. NJM is recognized for its outstanding auto claims experience by J. D. Power and is committed to serving customers in states like Connecticut, Maryland, New Jersey, Ohio, and Pennsylvania. The company prides itself on being straightforward and customer-focused, without jingles or mascots, offering trusted insurance solutions and multiple discount opportunities for various policies.

📋 Description

• Responsible for supporting the Quality Management department with improvements through project planning, development and implementation • 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 • 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 • Responsible for budgeting, cost containment and strategic planning of systemic enhancements to improve quality and efficiency of project initiatives and yearly interventions • 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 • Provide Consumer Assessment of Healthcare Providers and Systems (CAHPS) coaching to the Horizon providers community to improve the member experience

🎯 Requirements

• 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

🏖️ Benefits

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