Quality Outreach Specialist

jobs-near-me.org

<div class="isg-job-description“>

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

This positon is responsible for the coordination, implementation, and monitoring of all Commerical (Stars) HEDIS member and provider outreach, engagement, and intervention. This positon is also responsible for assisting Manager, Outreach & Interventions operationalize all initiatives to improve our HEDIS performance by working with internal and external stakeholders.

Responsibilities:

• Collaborate in designing, implementing, and monitoring all outreach and intervention progress with management.

• Builds and maintains relationships with Member Experience, PC&S, Govt. Program Communications, Enterprise Communications, Analytics, as well as external vendors to assist in implementing all initiatives to improve HEDIS performance.

• Support manager in monitoring initiatives and performance for all vendors and make sure initiatives are within budget and consistent with expectations to improve performance.

• Collects, analyzes and synthesizes data for the development of materials to guide departments decision making for Medicare and Medicaid populations’ health management, cost of health care management, and quality of care.

• Compile comprehensive monthly, quarterly, annual reports to summarize the efficacy and impact of all interventions to assist with strategic approach to improve HEDIS performance. Includes developing summary documents and reports related to provider outreach, engagement, and intervention activities.

• Participates in outreach activities for the program as appropriate. Develops outreach and in-reach materials to promote services.

• Facilitate and participate in meetings and presentations with internal and external audiences.8. Performs other related duties as assigned or directed.

Disclaimer:

This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

education/Experience:

• High School Diploma/GED required.

• Requires a minimum of 3 years experience in Population Health Management or 3 years of experience with social determinants of health for behavioral health

• Experience and understanding of NCQA, HEDIS, or URAQ standards.

• Requires 3 – 5 years managed care experience.

Knowledge:

• Requires knowledge of health care delivery systems, distribution channels, health care industry and health insurance industry.

• Knowledge of applicable laws and regulations as well as of Governmental Agencies and Regulatory.

• Requires knowledge of HEDIS, CAHPS, and Stars for CMS.

• Knowledge of quality improvement methodology.

• Knowledge of PC’s and applicable software Application

Skills and Abilities:

• Requires excellent written and oral communication skills.

• Requires demonstrated aptitude for analytical thinking and ability to report findings accurately.

• Requires strong interpersonal, organizational and problem solving skills

• Requires strong project management skills.

• Requires strong relationship building skills to work collaboratively across departments/divisions.

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint); Should be knowledgeable in the use of intranet and internet applications.

• Prefers knowledge of user-oriented programming languages including SAS, SQL

Travel:

• Some travel required

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Salary Range:

$70,500 – $94,395

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.