Program Manager, Clinical Quality

The Role

The HEDIS Program Manager is responsible for developing, managing, and coordinating Health and Medical Management (HMM) quality improvement activities to improve or maintain optimal scores for HEDIS, HOS, QCR, and/or Stars measures.

The HEDIS Program Manager works closely and collaboratively with all HMM areas, Performance Measurement and Improvement, Marketing, and other key departments throughout BCBSMA to support quality improvement activities. The Program Manager reports progress and impediments toward progress on key improvement initiatives to the HEDIS/HOS Steering.

The Team

Under the direction of the Senior Program Manager, the HEDIS Program Manager works collaboratively with the Clinical Quality team members on work related to quality performance initiatives.

Key Responsibilities:

• Facilitate and lead projects and meetings such as HEDIS/HOS improvement, management of Continuous Quality Improvement (CQI) initiatives (Quality Work plan), analysis of competitor/industry benchmarks, and implementation of quality initiatives to drive Quality Performance measures.
• Analyze current HEDIS/HOS, Stars, and/or QCR performance, identify areas for improvement and develop initiatives that support/leverage prevention and wellness and PPO/HMO health plan benefits.
• Collaborate with internal stakeholders such as Performance Measurement and Improvement, MPC, and other stakeholders to maintain and improve NCQA, CMS, and/or QCR Ratings.
• Use CQI tools to facilitate improvement. Collect, analyze, and validate data used in quality initiatives and present findings both within BCBSMA and to external audiences (providers and/or, delegated entities etc.).
• Support activities to prepare and execute NCQA accreditation

Key Qualifications:

• Knowledge of CQI principles with the ability to identify and implement opportunities for improvement, manage clinical initiatives, develop metrics, and utilize reports to measure performance outcomes including analysis of competitor/industry benchmarks
• Familiarity with NCQA, CMS, and/or QCR regulatory standards and reporting
• Demonstrated ability to facilitate teams, work collaboratively with various levels within HMM, and to build consensus with stakeholders to develop & implement evidence-based/data driven interventions
• Project management, program management, program design, program implementation and measurement
• Proven excellent interpersonal, verbal, and written communications skills, with the ability to present information to a wide variety of audiences and to adapt quickly in a fast-paced dynamic organization

Education and Experience:

• Bachelor's degree in clinical discipline required; Master's Degree preferred and/or
• RN or clinical professional with active Massachusetts license preferred
• 3 years clinical experience or experience in managed care industry, and in quality improvement management
• Strong quality improvement and project management skills required, CPHQ Certification a plus

High school degree or equivalent required unless otherwise noted above

The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee's pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability.

This job is also eligible for variable pay.

We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees.

Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law.

WHY Blue Cross Blue Shield of MA?

We understand that theconfidence gapandimposter syndromecan prevent amazing candidates coming our way, so please don't hesitate to apply. We'd love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It's in our differences that we will remain relentless in our pursuit to transform healthcare for ALL.

As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting ourCompany Culturepage. If this sounds like something you'd like to be a part of, we'd love to hear from you. You can also join ourTalent Communityto stay "in the know" on all things Blue.

At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.