Manager, Quality Management

Job not on LinkedIn

October 31

🏖️ New Jersey – Remote

Although this job is listed in New Jersey, this company may be open to hiring remote in other states.

💵 $108k - $147.4k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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NJM Insurance Group

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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.

1001 - 5000 employees

Founded 1913

📋 Description

• This position is responsible for leading all aspects of Quality Management Clinical Operations & Audit and Quality Management Performance Reporting, including HEDIS and STARS performance for Horizon Government Programs. • Directs staff to support quality improvement initiatives specifically related to Quality Audit, HEDIS, Stars, and NQCA Accreditation • Develops policies and procedures to support quality improvement initiatives and processes • Participates in special projects as assigned by the Director. • Represents the department with internal customers and Sr. Leadership in the event of Director's absence • Interfaces with other teams and plan areas to assure consistent application of policies and procedures and to facilitate inter-unit/department projects. • Provides leadership and utilizes professional and communication skills to direct and motivate staff to ensure high-quality outcomes. • Represents the Plan with external customers, providers and external agencies and represents the unit on corporate issues and/or in the event of Director's absence • Manages, directs, and develops staff by providing feedback and coaching. • Administers performance, and salary review for staff. • Ensures staff meets all regulatory requirements and utilizes best practice methodology. • Develops annual HEDIS chart review training and administer inter rater reliability • Develops HEDIS provider chase strategy to meet Horizons goals • Oversees Quality Management compliance of HEDIS chart reviews and overreads. • Responsible for development and implementation of HEDIS Roadmap. • Develops and implements initiatives to improve HEDIS and Stars performance • Manages relationships and supports external providers to improve HEDIS and Stars performance • Collaborates with Value Based Programs and Provider Contracting and Services to manage provider quality performance. • Develops and implements strategies for quality improvement and initiatives. • Responsible for assuring timely correction of deficiencies, identification of problem providers and promptly reports difficulties or lack of cooperation to the Director of Quality Management. • Works with Utilization Management to develop related policies and procedures.

🎯 Requirements

• Requires a Bachelor's degree from an accredited college or university • Requires five (5) years experience in a healthcare setting: health plan, hospital, physician practice, or managed care organization • Requires a minimum of five (5) years quality management experience • Requires a minimum of five (5) years management experience • Requires project management experience • Masters Degree preferred • Prefers experience in continuous quality improvement and/or quality management • Active Unrestricted NJ RN License Preferred • Active Unrestricted NJ RN License Required for QM Clinical Operations • Requires knowledge of HEDIS, CAHPS, and Medicare Stars • Requires working knowledge of NCQA accreditation standards • Requires thorough knowledge of managed care products • Requires knowledge of MCO and Horizon BCBSNJ products, services and programs • Requires the ability to think analytically and to use logic in the solving problems • Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint & Outlook); • Should be knowledgeable in the use of intranet and internet applications.

🏖️ Benefits

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