Health Care Manager - HEDIS
Blue Cross Blue Shield of Michigan

Responsible for researching, planning, organizing, directing, implementing, and management of corporate programs and initiatives dedicated to enhancing health care value. Position operates within broad objectives to ensure optimum utilization of manpower and budget. Specialize in research, planning, development, implementation and leadership.

• 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.
• 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.
• 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.
• Act as a Health Care Consultant by developing strategies and programs to reduce health care benefit costs and improve quality of care.
• Collaborate with appropriate business areas to implement proposed solutions and manage programs to evaluate effectiveness and results.
• Ensure programs and initiatives encompass broad corporate scope and present significant variables.
• 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.
• Independently develop and plan, reports, papers and/or other materials.
• May have direct supervisory responsibility which includes performance reviews.
• Other duties may be assigned.

"Qualifications"

• 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.
• 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).
• Excellent analytical, planning, problem solving, verbal and written skills to communicate complex ideas.
• Excellent knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).
• Ability to work independently, within a team environment and communicate effectively with employees at all levels.
• Other related skills and/or abilities may be required to perform this job.

Department Summary / Preferences:

The HEDIS Health Care Manager will be primarily responsible for activities related to NCQA HEDIS quality management, analysis, and support. This includes but is not limited to:
• Regulatory HEDIS Management to meet audit requirements, survey data support, specification expertise and coordination with the HEDIS data teams.
• Regulatory HEDIS performance reporting & public comment coordination.
• Routine HEDIS quality results reporting to stakeholders.
• HEDIS question & answer support for internal and external business partners.
• HEDIS quality analysis related to changing trends, issues, and new measure specification.
• Provider quality incentive program reporting.
• Member quality gap in care campaign coordination to encourage members to get preventative and appropriate care.

In addition to the above preferences, the manager will coordinate and collaborate across key teams to maximize our HEDIS quality results and support our provider quality programs.

All qualified applicants will receive consideration for employment without regard to, among other grounds, race, color, religion, sex, national origin, sexual orientation, age, gender identity, protected veteran status or status as an individual with a disability.

This job has expired.