This role leads and supports quality strategy and operations initiatives focused on clinical data, HEDIS processes, and performance improvement. Responsibilities include managing projects related to data integration, HEDIS abstraction, NCQA audit support, clinical reporting, and the implementation and adoption of clinical and reporting applications. The role drives FEP’s annual HEDIS submissions, contributes to strategies to improve measure performance, collaborates with technical, analytic, and clinical partners, and delivers clear, targeted communication to diverse audiences. Success requires clinical expertise, strong organizational and management skills, and a proactive, curiosity driven approach to learning and new responsibilities.
- Leadership and Initiative Management: Manages and provides leadership for various initiatives, including clinical data integration and governance, with a focus on quality improvement and care coordination.
- Project and Data Management: Oversees and significantly contributes to the execution of complex, cross-functional projects. Manages the collection, analysis, and synthesis of data, utilizing various research methodologies and data models.
- Stakeholder Engagement: Represents the department in internal and external groups, conferences, and meetings. Builds and maintains relationships with internal and external business partners, serving as a liaison among stakeholders.
- Process Improvement and Best Practices: Conducts analyses of best practices in the health industry, identifies issues, and recommends initiatives to address data quality and integrity. Develops strategies and recommendations to meet objectives and may lead or participate in implementation teams.
- Technical and Business Liaison: Acts as a liaison between IT and the business, understanding technical aspects of solutions, business systems, and software. Provides oversight and guidance in resolving complex issues and supports division budget and objectives.
The posting range for this position is:
$103,677.00-$149,129.62
Qualifications:
Education
- Required Bachelor's Degree or equivalent work experience
Experience
- Required 5+ Years experience within a health plan or health services delivery setting with experience in clinical quality, operations, claims processing, provider contracting, research, analytics, and/or healthcare informatics
Knowledge Skills and Abilities
- Ability to build consensus for business results in a decentralized decision-making structure, relying on excellent process management and conflict management skills including advanced time and resource management skills.
- Excellent communication (written and oral) and interpersonal skills with an ability to communicate to small and/or large audiences (both internal and external to BCBSA)
- Advanced analytic skills with the ability to analyze and interpret data through complex analysis.
- Demonstrate curiosity and determination in pursuing complex and innovative approaches to data analyses.
- Knowledge of SAS, SQL, Cognos, or MCSource.
Certifications & Licenses
- Preferred: CHC - Certified Healthcare Compliance
- Extra Posting Information:
A minimum of five years experience within a health plan or health services delivery setting with experience in clinical quality, operations, claims processing, provider contracting, research, analytics, and/or healthcare informatics.
PC experience using database programs, spreadsheets, and word processing, including all components of MS Office (particularly MS Excel and MS Access).Experience in consulting on and implementing cost-effective care management programs. Experience working with large data repositories and/or relational databases, as well as, experience with data mining. Experience with predictive modeling and risk stratification, including a working knowledge of quantitative analysis, disease prevalence, ROI, outcome measurements, benchmarks, trends and outliers.
#LI-Hybrid
The posted salary range is the lowest to highest salary we, in good faith, believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the hiring range andthis hiringrange may also be modified in the future. A candidate’s position within the hiring range may be based on several factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, and business or organizational needs. This job is also eligible for annual bonusincentivepay.
We offer a comprehensive package of benefits including paid time off, 11 holidays, medical/dental/vision insurance, generous 401(k) matching, lifestyle spending account and many other benefits to eligible employees.
Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law.