Join Our Team: Do Meaningful Work and Improve People’s Lives
Our purpose, to improve customers’ lives by making healthcare work better, is far from ordinary. And so are our employees. Working at Premera means you have the opportunity to drive real change by transforming healthcare.
To better serve our customers, we’re creating a culture that promotes employee growth, collaborative innovation, and inspired leadership. We are committed to creating an environment where employees can do their best work and where best-in-class talent comes, stays, and thrives!
Who we are:
Working through and with the Premera organization, its providers, and purchasers, our purpose is to develop and deploy holistic, customer-centric quality improvement solutions that address the four customer problems of: cost, necessary care, unnecessary care, and experience. We are proud to receive accreditation with the National Committee for Quality Assurance (NCQA). Possessing accreditation is shorthand for "We are doing the right things, at the right time for our customers."
The Manager for Quality Measurement is a health care quality professional responsible for the design, implementation, evaluation, and ongoing management of the following quality program processes and outcomes: Quality Measurement, Analytics, External Reporting and Submission, Quality Data Mining, Trending and Forecasting, Internal Reporting, and Quality Data Assurance and Optimization, for the lines of business offered by Premera.
The Manager leads a team of analysts and subject matter experts to ensure customer expectations are exceeded, outcomes are improved, and public reporting, contractual, and regulatory requirements are consistently executed, evaluated, and improved. This position also oversees the team responsible for HEDIS Medical Record Review (MRR) process including retrieval, abstraction, and validation efforts.
Strongly seeking candidates who possess the following:
Proven leadership qualities with the ability to effectively influence at all levels within the organization.
Knowledge of healthcare trends and technologies.
Strong verbal and written communication skills including strong presentation skills.
Strong critical thinking skills.
Strong customer focused orientation.
What you'll do:
Oversee and manage the Quality Measurement work streams to ensure the optimization of structures and processes and achieve goals and objectives. Implement activities, resources, methods, and procedures to achieve improvement in HEDIS measures. Oversee operational procedures to ensure compliance with HEDIS technical specifications, policies, systems and protocols, and internal and external guidelines
Implement activities, resources, methods, and procedures to achieve improvement in HEDIS measures
Oversee operational procedures to ensure compliance with HEDIS technical specifications, policies, systems and protocols, and internal and external guidelines
Collaborate with internal and external stakeholders in the selection and reporting of performance measures and in the development and implementation of quality improvement initiatives.
Provide comprehensive analysis of HEDIS measures, barriers, and opportunities and present results of improvement efforts and ongoing performance measures to health plan leadership
Ensure creation and maintenance of standardized work including documentation to preserve institutional knowledge, optimize processes, and deliver clear audit trails. Create, manage, and continuously develop, effective, high-performance Quality Measurement team to accomplish objectives.
Create, manage, and continuously develop, effective, high-performance Quality Measurement team to accomplish objectives.
Manage interdependencies and resolve cross-functional issues, providing resources and direction as needed.
Articulate program status (proactively and routinely) to internal and external committees, customers, and other audiences, advising leadership on key strategic initiatives, risks and opportunities related to short and long-term organizational goals. Review / approve quality measurement & reporting focused communications materials.
Lead change control processes to ensure program budget, schedule, and scope are maintained within the approved program baselines.
What you'll bring:
Bachelor’s degree in Healthcare Statistics, Information Management, an applicable discipline, or four (4) years of relevant experience.
Eight (8) years’ experience with collecting, analyzing, and reporting on data/metrics to include:
Experience with SQL, HEDIS and CAHPS
Two (2) years of quality program experience
Two (2) years of experience managing complex projects
Two (2) years of people management experience
Internal Number: R21843
About Premera Blue Cross
Working at Premera
More than 2 million customers count on us for comprehensive health benefits and services. This isn't a responsibility we take lightly. All 3,200 of us are dedicated to showing up for our customers.
As the leading health plan in the Pacific Northwest, we serve everyone from individuals to employees of Fortune 100 companies. Our services include innovative programs focused on health management, wellness, prevention, and patient safety. We deliver these programs through health, life, vision, dental, disability, and other related products and services.
Premera Blue Cross is headquartered in Mountlake Terrace, WA, with operations in Spokane and Anchorage. The company has operated in Washington since 1933 and in Alaska since 1952. With more than 80 years of experience in the region, we deliver innovation, choice, and expertise.