Healthcare Quality Analyst

Job not on LinkedIn

🕒 2 days ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $97.8k - $133.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• 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

🎯 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