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Quality Management Specialist - GP

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POST DATE 8/31/2016
END DATE 1/18/2017

Horizon Blue Cross Blue Shield of New Jersey Trenton, NJ

Trenton, NJ
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
Bachelors Degree


Job Summary:

This position is responsible for supporting the Quality Management department with improvements through project planning, development and implementation, and the establishment of policies and procedures pertaining to the DMAHS, HEDIS and Medicare Star Program.


* Develop project initiatives, process and performance measures for Quality Management and deliverables to ensure positive outcomes defined by corporate objectives and NCQA and regulatory regulations.

* Analyzes complex data and information to provide meaningful results, identifying success factors and improvement opportunities, recommending potential solutions to assist Government Programs set strategic goals.

* Measure performance goals of STAR plans and initiatives to ensure effectiveness of process. Report findings to management and stakeholders as appropriate.

* Responsible for budgeting, cost containment and strategic planning of systemic enhancements to improve the quality and efficiency of project initiatives and yearly interventions.

* Reviews all HPMS and industry correspondence, related to Star Ratings in order to assist and remain current on all information and decision. Ensures that all information necessary for decision making is coordinated and any necessary documentation is prepared.

* Collaboratively serve as a divisional resource with the Manager for health plan quality ratings.

* Interacts with internal and external stakeholders to promote Governments Programs clinical and operational improvement activities.


* Requires a Bachelor s Degree in Health Management or related field. Prefer Master s degree in business, nursing, public health, health science, health economics, data systems, health promotion or related field.

* Requires five (5) years professional business experience working in a health care environment.

* Prefer five (5) years managed care experience.

Additional licensing, certifications, registrations:


* Requires knowledge of project management methodology.

* Requires knowledge of healthcare management.

* Requires working knowledge of PC and application software.

* Requires knowledge of CMS STAR ratings, performance measurement and regulatory reporting.

Skills and Abilities:

* Requires the ability to apply project management methodologies and practices across multiple projects.

* Requires comprehensive leadership and decision making ability.

* Requires excellent analytical and problem solving skills.

* Requires excellent verbal and written communications skills.

* Require excellent presentation skills.

Travel (If Applicable):

The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.

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.



Job Level
Individual Contributor

--Horizon NJ Health

Job Type
Full Time

Trenton, NJ