Resp & Qualifications
1. Define and measure the performance of the health plan in facilitating and coordinating high-quality care leading to ideal health outcomes
- Building trust-based relationships with CareFirst’s clinical and business leadership to develop a deep understanding of their population health-related needs and challenges
- Designing and leading initiatives to collect actionable performance data from disparate sources (providers, employers, members, etc.), including retrieval and abstraction of clinical data
- Identifying and utilizing rich public and proprietary data sources to generate new and meaningful metrics
- Developing reports, project management support systems, and strategies to optimize HEDIS/QRS/CAHPS/QHP/QCR data collection and measurement
2. Analyze and evaluate 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
- Utilizing a variety of quantitative and qualitative methods of analysis to conduct population health analyses
- Elucidating technical documentation and data requests; researching clinical definitions, quality metrics, and coding standards as necessary
- Analyzing the performance of HEDIS/QRS/CAHPS/QHP/QCR across and within products and populations compared with both internal and external benchmarks
3. Prioritize, develop, and operationalize these opportunities in collaboration with other functional areas of the organization into innovative programs and interventions
- Exploring and investigating best practices and innovations from within and beyond the industry that are applicable to CareFirst strategic goals
- Drawing from research, measurement, analysis, and evaluation to design solutions intended to meet CareFirst strategic goals
- Creating and delivering data-driven storylines and presentations on identified opportunities and potential high-impact solutions that persuade and engage CareFirst leadership
- Working in cross disciplinary teams to translate findings and innovative program design into concrete, operationalized action that leads to improved population health outcomes
4. Act as the organization’s subject matter expert in quality measurement (10%) • Attaining a complete understanding of quality measurement standard specifications
- Developing an awareness and comprehension of quality measurement organizations and programs (ex. NCQA, NQF, CMS, OPM, Medical Societies, etc.)
- Understanding the driving forces behind quality measurement organization decisions and working towards predicting future quality measurement foci
- Synthesizing knowledge in such a way that it can be presented to and understood by those who have no current or hands-on experience with quality measurements
- Bachelor’s degree in business administration, health policy, health services research, public health, economics, mathematics, computer science, or a related field;
- 3+ years of professional experience in a business environment (public health, health insurance, management consulting fields preferred); evidence of progressing levels of responsibility.
- Demonstrated expertise in the creation of qualitative and quantitative data analyses and analytic presentations
- Experience designing, developing, and implementing innovative strategies to improve healthcare or other similarly complex, regulated systems
- Superb strategic, analytic, problem solving, and communication skills;
- Able to learn the technical aspects of collection and reporting of quality measures.
- Strong teamwork and interpersonal skills, an ability to present and discuss information in a way that establishes rapport, persuades others, and gains understanding;
- Comfortable with ambiguity and able to set your own direction;
- Strong project management and organizational skills;
- Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple project demands from internal and external partners. Must be able to effectively communicate and build strong relationships with every internal and external partner, including partners who may be demanding or otherwise challenging.
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
Please apply before: 7/1/2018
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.
The physical demands described below are representative of those that must be met by an associate to perform the essential duties and responsibilities of the position successfully. Requirements may be modified to accommodate individuals with disabilities.
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 employee must frequently talk, see, and hear. Weights of up to 25 pounds are occasionally lifted. Occasional driving is required.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship