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Senior Program Manager HEDIS (Healthcare Effectiveness Data and Information Set)

Employment type: 
Full time
Remote Position: 
Required degree level: 

Job Description Summary

Responsible for leading multiple quality initiatives, projects, research, and associated deliverables related to improving clinical care and member satisfaction for the BCBSA Federal Employee Program (FEP). Leads the development of concepts and materials designed to support BCBSA Plans to improve HEDIS and CAHPS measures included in the Office of Personnel Managements (OPM's) Quality of Care, Customer Service and Resource Use (QCR) measure set. Conceives and develops innovative approaches to improve care and service to FEP members at the FEPDO and in support of Plans. Gathers and analyzes data, reports, and vendor outcomes to determine the impact of existing programs and pilots. Uses clinical expertise and health communications skills to develop and evaluate Plan- and member-facing content and materials (such as the FEP Provider Toolkit), member messaging and resources via multiple channels (website, direct messaging, mailers, explanation of benefits statements, etc.). Catalogs all member messaging and programs related to OPM QCRs. Works with other FEPDO departments to provide support and resources to Plans for quality improvement. Researches, distills and presents best practices related to the HEDIS QCRs both internally and at Plan forums, such HEDIS Improvement Team Town Hall calls and the Quality Oversight Group. Leads cross-functional projects and teams developing initiatives and interventions to meet Plan needs. Supports FEPDO departments with clinical and health care system knowledge and expertise. Facilitates FEPDO and staff meetings. Increases the value of FEPDO programs and services to meet the needs of Plans, other BCBSA departments and other key customers.

Responsibilities include but are not limited to:

  • Informed by empirically based best practices, develops and maintains Plan- and member-facing materials and platforms (such as Zavanta and BlueWeb) aimed at improving member and provider compliance with HEDIS and CAHPS QCR measures. Work with other FEPDO departments for consensus around, and recommendations for, priorities for interventions to improve the FEP QCCR scores and research and development of quality improvement materials and initiatives. Monitors, documents and disseminates to Plans FEPDO activities aimed at improving the QCRs, including developing and delivering high quality PowerPoint presentations. Delivers content for the FEP Quality Oversight Group (QOG) and plays a key role in managing the QOG conferences, both virtual and on-site Disseminates content and learnings via the Plan-facing HEDIS Improvement Team Town Hall Call (HIT). Annually identify Plan high and low performers in HEDIS and CAHPS FEP results. From these findings, and with other FEPDO staff, confer with low performers on tools and strategies to improve care and services. For high performers, curate content for dissemination to all BCBSA Plans through written materials and Plan presentations. Manage the execution of the Plan Blue Apple and Pink Bird of Hope awards for best performance in HEDIS metrics, which involves communicating with Plans to develop posters for on-site conferences and other presentations for dissemination to the BCBSA system.
  • Through literature review and data research, develops and processes proposed FEPDO strategy and suggested Plan strategy to improve the QCR measures. Conceptualizes and implements member research projects with the FEP Research area. Resolves complex issues and develops and evaluates Plan and member communication strategies to assure impactful quality interventions Uses clinical knowledge to develop member and provider collateral content. Evaluates Plan FEP quality improvement budgets for appropriateness.
  • Support and assist Plans in the use of strategies and materials to achieve high levels of FEP quality improvement performance. Summarizes research and best practice findings in PowerPoint presentations for internal senior managers and for Plan presentations. Supports FEP national conferences and management through developing content and PowerPoint presentations.
  • Evaluates Plan and FEP Pilot programs to determine impact on HEDIS QCRs. Summarizes results into engaging PowerPoint formats for presentations to disseminate learnings.
  • Represents department at key meetings including the HEDIS Improvement Team Town Hall Call, Quality Oversight Group and internal meetings. Provides updates and status reports on key quality issues to management.
  • Assists other Quality and Accreditation Operations department staff in development of presentations (such as for internal meetings, Office of Personnel Management presentations, etc.) and at Plan-facing meetings and forums. Represents the Quality and Accreditation Operations department on vendor evaluation and acquisition projects. Clinical consultative support to other FEPDO areas as needed, such as evaluation of website verbiage and member and provider mailers. Provides direction on impactful quality improvement interventions and cross-functional initiatives, as appropriate.

Required Education, Certifications and Experience

  • Bachelors degree in Nursing, Public Health, Health Education, Health Policy and Administration or Epidemiology
  • Minimum 5 years related business experience which demonstrates knowledge of health plan systems, including BCBSA Plan operations and practical quality improvement strategies
  • Minimum 5 years exoerience as an expert in continuous quality improvement methods with demonstrated knowledge of HEDIS and CAHPS performance measures; history of performance improvement
  • Excellent interpersonal and communication skills, particularly writing for consumers and health plan audiences
  • Analytical skills with the ability to analyze and present data, interpret data and translate complex concepts into digestible information (such as for member mailers and website content) for a variety of audiences
  • Translating data to meaningful recommendations for improvement, and interpreting into PowerPoint presentations (charts, graphs, SmartArt, etc.)
  • Meeting management and conflict management skills
  • Ability to lead multiple priority projects in a fast-paced environment, while meeting deadlines
  • Advanced presentation skills with the ability to plan, facilitate and present at virtual and on-site meetings; advanced PowerPoint skills
  • Relationship management skills to interact effectively with all levels of staff and management, both internal to BCBSA and with BCBSA Plan staff
  • Knowledge of NCQA HEDIS and CAHPS measures, and ability to interpret and apply HEDIS and CAHPS specifications and results

Preferred Education, Certifications and Experience

  • Masters degree in Public Health, Health Education, Epidemiology Licensed Nurse or Health Care Professional
  • Health Educator degree or certification
  • Licensed Nurse or Health Care Professional
  • Two years experience developing consumer health communications (ex: mailers for gaps in care, website content, etc.), particularly for improvement of preventive care and chronic diseases
  • Two years experience in data analysis and reporting, strong PowerPoint presentation skills

People Management - No

Make an impact on healthcare in America. A career with Blue Cross Blue Shield Association allows you to be part of the foundation that supports the 35 Blue Cross and Blue Shield companies nationwide, while protecting and strengthening the Blue Cross Blue Shield brand. Our work is helping provide greater access to cost-effective healthcare, improve the health of America and build stronger communities. With a commitment to diversity, equity and inclusion, we celebrate different cultures, languages, backgrounds and experiences while striving to advance health equity, and we want you to join Team BCBSA.

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