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

Job Summary:

The Clinical Quality Improvement Liaison is responsible for managing HEDIS and Stars performance by working with low performing providers to identify areas of opportunity. The CQA will be the main Quality contact for providers, they will provide guidance and resources in order for the provider to achieve target Quality Performance metrics, as established by the National Committee for Quality Assurance.Responsibilities:

Primary liaison for the Quality Management department and all assigned provider groups to improve HEDIS and Stars Quality Performance.

Monitor and analyze provider Quality Performance Reports. Identify areas of improvement, provide assistance with root cause analysis, assists with developing solutions, and develop a work plan to monitor progress.

Conduct on-site visits on a regular basis to implement the work plan and to conduct provider education sessions regarding appropriate coding practices and chart documentation.

Collaborate with Value Based Programs and Provider Contracting and Services to manage provider quality performance.

During HEDIS season, assists with the retrieval of charts, chart abstraction, and chart review entries. CQM must adhere to the HEDIS guidelines for chart review abstractions and standards.

Provide HEDIS provider guidelines that highlight appropriate HEDIS codes for claims submission.

Assists in the development of member and provider outreach, engagement, and education materials to improve Quality Performance.

Completes other assigned functions, including special projects, as requested by management.

Conducts training for new and current staff on processes that will result in improving HEDIS and Stars Quality Performance.

Creates and updates processes, work plans and policies.

Aggregate monthly project performance metrics.

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:

Requires Bachelor's degree from an accredited college or university, preferably in Healthcare or related field. In lieu of degree applicant must have an additional 3 years of equivalent and relevant work experience.

Requires a minimum of three (3) years experience in a behavioral healthcare setting: health plan, hospital, physician practice, or managed care organization

Prefers experience in continuous quality improvement and/or quality management.

Additional licensing, certifications, registrations:

No Regulatory Requirement; Active Unrestricted NJ Clinical license strongly preferred.

Knowledge:

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

Prefers knowledge of Population Health Management and Preventative Management Programs.

Prefers Project Management skills.

Skills and Abilities:

Requires excellent verbal and written communication skills.

Analytical & Problem Solving

Continuous Improvement

Information & Knowledge Sharing

Process Management

Interpersonal & Client Relationship

Presentation Skills

Travel % :

Up to 30% Travel to Provider Offices

Salary Range:

$76,800 - $102,795

​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

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.