CareFirst Careers

Manager, Quality - HEDIS (Hybrid)

Resp & Qualifications

PURPOSE:
The HEDIS Quality Manager is responsible to plan, organize, direct, control, and lead the assigned business unit responsible for HEDIS medical record review processes, year-round supplemental data abstractions, and client reporting.This role manages a team responsible  in defining, measuring, analyzing, and evaluating quality improvement, while prioritizing, developing, and operationalizing innovative programs and interventions to address the opportunities discovered through their analysis. Creates complex quality measurement collections and identifies opportunities and implement quality improvement interventions. We are looking for an experienced people leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week.

ESSENTIAL FUNCTIONS:

  • Manages and develops a team.

  • Evaluates the performance of the health plan using available data against the market and best practices to identify opportunities. Working with clinical and business leaders to collaboratively develop and implement analytic problem-solving approaches to strategic clinical challenges. Prioritize, develop, and operationalize these opportunities in collaboration with other functional areas of the organization into innovative programs and interventions.

  • Manages initiatives to collect actionable performance data from disparate sources (providers, employers, members, etc.), including retrieval and abstraction of HEDIS/quality clinical data.

  • Maintains  knowledge of current NCQA, HEDIS, state and federal regulatory and healthcare quality, clinical practices, and quality measurement requirements and standards; Monitors compliance to accreditation and regulatory requirements and engages functional leaders to support quality efforts.

  • With the Director, determines best practices and innovations from within and beyond the industry that are applicable to strategic goals. Creating and delivering data-driven storylines and presentations on identified opportunities and potential high-impact solutions that persuade and engage leadership

  • Improve the quality and safety of clinical care and services provided to members. Evaluates the effectiveness of quality measurement and activities to identify and prioritize process improvements and gaps in care.


SUPERVISORY RESPONSIBILITY:
This position manages people.

QUALIFICATIONS:

Education Level: Bachelor's Degree in business administration, health policy, health services research, public health, economics, mathematics, computer science, or a related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience:

  • 5 years experience in a healthcare, public health, health insurance, quality/process improvement or data management business environment.
  • 1 year supervisory experience or demonstrated progressive leadership experience.

Preferred Qualifications:

  • Training or certification in Quality or Process Improvement Methods.

Knowledge, Skills and Abilities (KSAs)

  • Ability to perform qualitative and quantitative data analyses and create innovative strategies and work with colleagues to address findings; and
  • Ability to learn the technical aspects of collection and reporting of both administrative and clinical aspects of quality measures.
  • Strong computer skills to include Microsoft Office.
  • Strong leadership skills.
  • Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

 

Department

Department: Accreditation & Medical Program

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Hire Range Disclaimer

Actual salary will be based on relevant job experience and work history.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

#LI-CT1

 

Not finding the right job?
Stay informed about future openings by joining one of our Talent Networks!

Learn more about Medical Management