Manager, Quality & Population Health

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="" 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="" 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="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.

keywords: management,analysis,compliance,operations,performance,quality assurance,support,experience,degree,license


Competitive Compensation and Benefits Package

Overview: Responsible for direct supervision of HEDIS quality management staff and HEDIS medical coder staff, under the direction of the Quality & Population Health Director.
Responsibilities: <ul> <li>Oversight of annual HEDIS/STAR activities including annual EMR Audit, HEDIS fall medical record reviews and supplemental data collection for prospective HEDIS.</li> <li>Responsible for updating HEDIS specifications/information for managed care publications for practitioners, providers and members in newsletters, manuals, handbooks and website.</li> <li>Evaluates monthly HEDIS rates, to identify problems, provide analysis of barriers and develop recommendations for interventions and incentives, to positively impact HEDIS/STAR rates.</li> <li>Participates on multidisciplinary committees and work teams, maintaining professional relationships with practitioners, providers, members and other external customers.&nbsp; Identify opportunities for HEDIS rates improvement.&nbsp; Responsible for maintaining confidentiality in all aspects of departmental operations involving physicians, providers, members and external entities.</li> <li>Serves as liaison for other departments in achieving compliance with HEDIS measures, supports corporate accreditation and regulatory initiatives, e.g. NCQA, CMS, etc.</li> <li>Actively and effectively communicates with Quality and Population Health (QPH) leadership including other QPH Managers, QPH Director, and VP of Health and Care Affairs regarding issues in the state that might impact HEDIS measures.</li> <li>Assists with requests for information/answering Health eBlue Web questions and special reports for department.</li> <li>Uses independent judgment to exercise authority on behalf of the company and recommends such actions in the following areas:</li> <li>Writing HCV business cases to support staff requirements for QPH area.</li> <li>Interviews and makes hiring and transfer recommendation/decisions regarding staff for the department.</li> <li>Conducts performance evaluations, counsels, coaches, and administers discipline.</li> <li>Responsible for ensuring staff training and development</li> <li>Keeps abreast of changes in corporate policies/procedures, and communicates changes with staff</li> <li>Resolves employee complaints and concerns; maintains good employee relations</li> <li>Develops and/or assists in budget preparation and adheres to budget.</li> <li>Assist the QPH Director with activities related to the HEDIS including expectations of HEDIS goals for rates, HEDIS interventions/incentives, and the implementation of departmental budget.</li> </ul>
Requirements: <ul> <li><span style="font-size: medium;">Bachelor's Degree in Nursing, Business Administration, Health Care Administration or related field required. Must be a graduate of an accredited registered nursing program with a current unrestricted Michigan license. Master's Degree preferred.</span></li> <li><span style="font-size: medium;">Three years of clinical practice as an RN required.</span></li> <li><span style="font-size: medium;">Three years experience in medical record review and data abstraction for HEDIS activities&nbsp;required.</span></li> <li><span style="font-size: medium;">Two years supervisory or management experience required.</span></li> </ul>