HEDIS Initiatives Manager

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Southfield, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />Learn more about your options as an external candidate. <a href="https://bcbsm.taleo.net/careersection/2/jobsearch.ftl?lang=en" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

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Competitive Total Compensation Package

Overview: <strong><strong><span style="font-size: small;">Responsible for researching, planning, organizing, directing, implementing, and management of corporate programs and initiatives dedicated to enhancing health care value.&nbsp; Position operates within broad objectives to ensure optimum utilization of manpower and budget.&nbsp; Specialize in research, planning, development, implementation and leadership.<br /><br /></span></strong></strong> <div><strong><span style="font-size: small;">Department&nbsp;Summary / Preferences:</span></strong></div> <div><span style="font-family: Calibri;"><span style="font-family: Arial; font-size: small;">Responsible for coordinating and facilitating&nbsp;quality data and interventions for defined markets and identifying opportunities to impact HEDIS measures, developing programs and initiatives, creating action plans and execution methodologies.&nbsp;This includes HEDIS reports analyses, planning and coordination of HEDIS outreach efforts and evaluation of effectiveness such efforts.&nbsp;Responsible for&nbsp;serving as a liaison across departments to support population health management programs and quality improvement activities under the direction of Director of Population Health Management.</span>&nbsp;</span></div> <strong><span style="font-size: small;"><br /></span></strong>
Responsibilities: <ul> <li><span style="font-size: small;">Utilize data analytics and extensive business knowledge to manage the research, analysis, identification and evaluation of data from identified problems to evaluate existing and potential trends, competition, and issues.&nbsp;</span></li> <li><span style="font-size: small;">Possess and maintain in-depth knowledge of BCBSM business, products, programs (including claims, reimbursement, benefits, provider and program data, networks, etc.), corporate organizational structure (including functional responsibilities), and complex research principles/methodologies.&nbsp;</span></li> <li><span style="font-size: small;">Lead and monitor multidisciplinary corporate programs/projects simultaneously by managing the establishment of project plans and objectives to ensure goal attainment within defined parameters. Develop solutions to complex issues and present recommendations to senior management as well as employees at various corporate levels.&nbsp;</span></li> <li><span style="font-size: small;">Act as a Health Care Consultant by developing strategies and programs to reduce health care benefit costs and improve quality of care.&nbsp;</span></li> <li><span style="font-size: small;">Collaborate with appropriate business areas to implement proposed solutions and manage programs to evaluate effectiveness and results<em>.</em>&nbsp;</span></li> <li><span style="font-size: small;">Ensure programs and initiatives encompass broad corporate scope and present significant variables.&nbsp;</span></li> <li><span style="font-size: small;">Anticipate, identify, and resolve challenges in order to fulfill key corporate objectives and respond to the demand of change management and initiate actions needed to plan, organize and control team activities.&nbsp;</span></li> <li><span style="font-size: small;">Independently develop and plan, reports, papers and/or other materials.&nbsp;</span></li> <li><span style="font-size: small;">May have direct supervisory responsibility which includes performance reviews.&nbsp;</span></li> <li><span style="font-size: small;">Other duties may be assigned</span>. <div>&nbsp;</div> </li> <li> <div><span style="font-size: small;">Manage HMO and PPO HEDIS initiatives program including reports, analysis, coordination of HEDIS-focused outreach efforts, and evaluation of effectiveness.</span></div> <div>&nbsp;</div> </li> <li> <div><span style="font-size: small;">Collaborate with relevant administrative and clinical staff to coordinate, design, and implement HEDIS-focused initiatives.</span></div> <div>&nbsp;</div> </li> <li> <div><span style="font-size: small;">Participate in HEDIS and medical record standards data collection and design of tools for collection of health information.</span></div> <div>&nbsp;</div> </li> <li> <div><span style="font-size: small;">Work with the analytics team to organize, compile and interpret data for trending and reporting.</span></div> <div>&nbsp;</div> </li> <li> <div><span style="font-size: small;">Provide support for QI initiatives, health management programs, behavioral and preventive health activities, clinical and preventive health guidelines, member and provider materials, data analysis, and outcome measurement.</span></div> <div>&nbsp;</div> </li> <li> <div><span style="font-size: small;">Coordinate preparation and distribution of health education materials including mailings, newsletters, registry, member phone calls, and provider interventions and/or perform interventions related to identified clinical areas necessary to improve population health.&nbsp;&nbsp;</span></div> <div>&nbsp;</div> </li> <li> <div><span style="font-size: small;">Work with the leadership to identify strategies and opportunities for improving the health status of plan&rsquo;s membership.</span>&nbsp;</div> <div>&nbsp;</div> </li> <li> <div><span style="font-size: small;">Participate in the development of health management system programs, clinical practice guidelines and preventive health initiatives.&nbsp;</span></div> <div>&nbsp;</div> </li> <li> <div><span style="font-size: small;">Work with network providers affairs staff to implement identified improvement processes.</span></div> <div>&nbsp;</div> </li> <li> <div><span style="font-size: small;">Answer member questions regarding preventive health care initiatives, wellness initiatives and disease management initiatives, and other health related concerns as necessary.&nbsp;&nbsp;</span></div> <div>&nbsp;</div> </li> <li> <div><span style="font-size: small;">Coordinate operational activities related to vendor for clinical data collection.</span></div> <div>&nbsp;</div> </li> <li> <div><span style="font-size: small;">Mentor, coach, and evaluate staff performance.</span></div> </li> <li><span style="font-size: small;">Perform departmental administrative functions including budget preparations, variance reporting, maintenance of departmental policy and procedure manuals.</span></li> <li><span style="font-size: small;">Collaborate clinical data related activities with registries, Health Information exchanges, EMR vendors etc.</span></li> </ul>
Requirements: <div id="requisitionDescriptionInterface.ID1510.row1" class="contentlinepanel" title=""> <div><strong><span style="font-size: small;">Education and Experience:</span></strong></div> <ul> <li><span style="font-size: small;">Bachelors degree in Healthcare related field, public health, health care research, health care administration or related field required. Masters degree in relevant field preferred.</span></li> <li><span style="font-size: small;">Comprehensive knowledge of regulatory and accreditation requirements for reporting including NCQA (including HEDIS), HCFA and MDCH requirements. Comprehensive knowledge of administrative data sources including standard coding schemes (ICD-10CM, CPT, HCPCS), HCFA 1500 and UB92 formats.</span></li> <li><span style="font-size: small;">Three years of clinical experience in a managed care setting required.</span></li> <li><span style="font-size: small;">Three years of demonstrated experience in quality improvement or research processes.&nbsp;</span></li> <li><span style="font-size: small;">Three years of&nbsp; experience working with clinical data registries and health information exchanges required.</span></li> <li><span style="font-size: small;">Proficiency in analyzing and interpreting healthcare data and trends.</span></li> <li><span style="font-family: Calibri;"><span style="font-family: Arial; font-size: small;">A team player with strong communication, leadership, management and interpersonal skills with ability to develop and professionally present educational programs/workshops.</span></span></li> <li><span style="font-size: small;">Demonstrated ability to manage multiple projects, tasks, and staff is a must.</span></li> <li><span style="font-size: small;">A self-starter with excellent problem solving, decision making and follow through skills.</span></li> <li><span style="font-size: small;">Strong knowledge of personal computer software applications including Microsoft Word, PowerPoint and Excel.</span></li> <li><span style="font-family: Calibri;"><span style="font-family: Arial; font-size: small;">Highly developed written and oral communication skills.&nbsp; Ability to communicate</span>&nbsp;</span><span style="font-size: small;">professionally and present information in a positive and motivating manner internally and externally at all levels</span></li> <li><span style="font-size: small;">Ability to work well with minimal supervision.</span></li> </ul> </div> <div id="requisitionDescriptionInterface.ID1566.row1" class="contentlinepanel" title=""> <div id="requisitionDescriptionInterface.ID1582.row1" class="inlinepanel" title=""><strong><span class="subtitle">Qualifications</span></strong></div> <ul> <li><span style="font-size: small;">Bachelor's Degree in Business Administration, Economics, Health Care, Information Systems, Statistics or other related field is required. Master's Degree in related field preferred.</span></li> <li><span style="font-size: small;">Seven (7) to Ten (10) years experience of related experience, typically in two (2) subject areas (e.g. financial analysis, planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management).</span></li> <li><span style="font-size: small;">Excellent analytical, planning, problem solving, verbal and written skills to communicate complex ideas.</span></li> <li><span style="font-size: small;">Excellent knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).</span></li> <li><span style="font-size: small;">Ability to work independently, within a team environment and communicate effectively with employees at all levels.</span></li> <li><span style="font-size: small;">Other related skills and/or abilities may be required to perform this job.</span></li> </ul> </div>