Healthcare Quality Analyst

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Accountable for aiding the Quality Management department in enhancing processes through project planning, development, implementation, and the formulation of policies and procedures in alignment with regulations for both Government Programs and Commercial business.

• Evaluates intricate data and information to deliver valuable insights, pinpointing success factors and opportunities for improvement, while recommending viable solutions to help the business achieve strategic objectives.

• Assess the performance goals of Medicare STAR Program plans and initiatives to verify the efficiency of processes.

• Communicate findings to management and relevant stakeholders as needed.

• Review all HPMS and industry correspondence related to Star Ratings to assist and stay updated on all pertinent information and decisions.

• Ensure that all necessary information for decision-making is organized, and any required documentation is prepared.

• Develop project initiatives, processes, and performance measures for Quality Management and deliverables to guarantee positive outcomes defined by corporate objectives and NCQA and regulatory standards.

• Oversee budgeting, cost management, and strategic planning of systemic enhancements aimed at improving the quality and efficiency of project initiatives and annual interventions.

• Collaboratively act as a divisional resource within HCM&T alongside the Manager for health plan quality ratings.

• Engage with internal and external stakeholders to advocate for HCM&T's clinical and operational improvement initiatives.

• Offer Consumer Assessment of Healthcare Providers and Systems (CAHPS) coaching to the Horizon providers community to enhance the member experience.

• Analyze member experience performance through diverse data sources.

• Assist in formulating provider improvement action plans to enhance member experience and boost CAHPS performance.

⛳️ Requirements

• High School Diploma/GED is mandatory.

• Bachelor’s degree is preferred or relevant experience may be considered in lieu of a degree.

• Requires five (5) years of professional business experience in a healthcare setting.

• Five (5) years of managed care experience is preferred.

• Must possess knowledge of project management methodologies.

• Knowledge of healthcare management is essential.

• Requires proficiency in PC and application software.

• Must have knowledge of performance measurement and regulatory reporting.

• SAS Coding experience is strongly preferred.

• HEDIS/Quality Initiative experience is strongly preferred.

• Experience with State Reporting is strongly preferred.

🏝️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision).

• Retirement Plans.

• Generous PTO.

• Incentive Plans.

• Wellness Programs.

• Paid Volunteer Time Off.

• Tuition Reimbursement.