Horizon Blue Cross Blue Shield of New Jersey · 18 hours ago
Manager, Quality Management
Hopewell, NJ
Full-time
Onsite
Mid, Senior Level
$110K/yr - $150K/yr
5+ years expHorizon Blue Cross Blue Shield of New Jersey empowers members to achieve their best health and has been a leader in health solutions for over 90 years. The Manager of Quality Management is responsible for leading Quality Management Clinical Operations and Audit, overseeing quality improvement initiatives, and ensuring compliance with HEDIS and STARS performance metrics.
Health Care
Responsibilities
Directs staff to support quality improvement initiatives specifically related to Quality Audit, HEDIS, Stars, and NQCA Accreditation
Develops policies and procedures to support quality improvement initiatives and processes
Participates in special projects as assigned by the Director
Represents the department with internal customers and Sr. Leadership in the event of Director's absence
Interfaces with other teams and plan areas to assure consistent application of policies and procedures and to facilitate inter-unit/department projects
Provide leadership and utilizes professional and communication skills to direct and motivate staff to ensure high quality outcomes
Represents the Plan with external customers, providers and external agencies and represents the unit on corporate issues and/or in the event of Director's absence
Manage, direct, and develop staff by providing feedback and coaching. Administer performance, and salary review for staff. Ensure staff meets all regulatory requirements and utilizes best practice methodology
Develop annual HEDIS chart review training and administer inter rater reliability
Develop HEDIS provider chase strategy to meet Horizons goals
Oversees Quality Management compliance of HEDIS chart reviews and overreads
Responsible for development and implementation of HEDIS Roadmap
Develops and implements initiatives to improve HEDIS and Stars performance
Management and oversight of Horizons Pay for Performance program
Conduct provider onsite visits to promote and support Pay for Performance program
Manage relationships and supports external providers to improve HEDIS and Stars performance
Collaborate with Value Based Programs and Provider Contracting and Services to manage provider quality performance
Develops and implements strategies for quality improvement and initiatives
Responsible for assuring timely correction of deficiencies, identification of problem providers and promptly reports difficulties or lack of cooperation to the Director of Quality Management
Interfaces with other teams and plan areas to assure consistent application of policies and procedures and to facilitate inter-unit/department projects
Works with Utilization Management to develop related policies and procedures
Qualification
Required
Requires a Bachelor's degree from an accredited college or university
Requires five (5) year experience in a healthcare setting: health plan, hospital, physician practice, or managed care organization
Requires a minimum of five (5) years quality management experience
Requires minimum of five (5) years management experience
Requires project management experience
Requires knowledge of HEDIS, CAHPS, and Medicare Stars
Requires working knowledge of NCQA accreditation standards
Requires thorough knowledge of managed care products
Requires knowledge of MCO and Horizon BCBSNJ products, services and programs
Requires the ability to think analytically and to use logic in the solving problems
Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint & Outlook); Should be knowledgeable in the use of intranet and internet applications
Requires excellent verbal and communication skills
Requires strong project management skills
Requires strong organizational skills
Requires strong problem solving and decision making skills
Requires good analytical skills, ability to interpret data to improve quality performance
Requires strong relationship building skills to work collaboratively across departments/divisions
Preferred
Masters Degree preferred
Prefers experience in continuous quality improvement and/or quality management
Active Unrestricted NJ RN License Preferred
Active Unrestricted NJ RN License Required for QM Clinical Operations
Benefits
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Company
Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products.
5001-10000 employees
H1B Sponsorship
Horizon Blue Cross Blue Shield of New Jersey has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (7)
2024 (7)
2023 (6)
2021 (1)
Funding
Current Stage
Late StageLeadership Team
Gary St. Hilaire
President & Chief Executive Officer
Recent News
2026-01-06
2025-12-29
2025-12-25
Company data provided by crunchbase