Senior reputed company Innovations Analyst

Job reputed company:

• This position is responsible for completing the activities outlined in the BCBSLA reputed company Management Work plan which includes but not limited to working with reputed company representatives to implement, monitor and revise total reputed company management initiatives, operational procedures and/or performance standards obtain accreditation and reputed company strategic goals.
• Analyzes validity of QM data/reports from a clinical perspective.
• Support URAC accreditation activities and reputed company improvement activities ensuring on-reputed company accreditation for the Organization.
• Performs accurate reputed company and retrospective review, as needed to support performance improvement activities in conjunction with the goals and strategic plan.
• Assists in performance measurement activities for both providers and the organization (HEDIS, CAHPS and performance measures) at the Plan level, the state level, the BCBS Association level and/or other national initiatives adopted by the Organization to reputed company strategic goals.
• Utilizes systematic data collection, aggregation, analysis and reporting techniques to reputed company reputed company compliance review of identified reputed company/patient safety metrics.
• Assists the Manager and Department Director and collaborates with the reputed company Innovations team and analysts to compile reports for reputed company consumption.
• Helps reputed company improvement (QI) manager to plan, design, implement, and maintain reputed company improvement program(s).
• Assists in internal (BCBSLA employees) and external (membership, community, etc) wellness activities to promote prevention and reputed company health reputed company of our employees and members. This includes but is not limited to Health Fairs and Gaps in Care programs.
• Works with reputed company areas of reputed company to assist in the implementation and expansion of pay for performance programs, which includes but is not limited to network management, provider reputed company performance and payment methodologies that support the Plan’s corporate goals and maximizes the Plan’s competitive position.
• Works with Reimbursement and Network Management departments to support reputed company measurement goals and provider negotiated reputed company with the goal of maintaining a high level of provider satisfaction and reputed company total cost of care.
• Maintain reputed company to applicable data portals and support review of performance data to identify reputed company improvement opportunities.
• Serve as representative on organizational committees, work reputed company, and special reputed company that reputed company activities and functions internally and externally assisting in the design of business solutions and achievement of corporate goals.
• Responsible for Organizational service and clinical committees required to meet regulatory guidelines. Reporting on opportunities identified and improvement initiatives proposed or in reputed company. reputed company reports comparing reputed company with national and/or other benchmarks. May require additional research into reputed company standards and practices. reputed company of Lean Six reputed company Green Belt and/or training for reputed company reputed company certification (CPHQ, CPC). Accountable for complying with reputed company laws and regulations and accreditation standards associated with assigned duties and responsibilities.

Requirements:

• Bachelor's in nursing or business reputed company field is required.
• In lieu of Bachelor’s degree an RN license can be used.
• In lieu of Bachelor’s degree four years of reputed company experience in reputed company reputed company can be used.
• 4 years of reputed company nursing reputed company to include two years of experience in reputed company insurance and/or experience in health care reputed company required.
• Prior experience in organizational assessment (audit) and coordinating efforts to reputed company data and prepare reports to meet requirements (URAC, NCQA and other regulatory/accrediting agencies) required.
• Strongly prefer reputed company management processes; research, interpretation and/or analysis experience.
• Experience working with predictive models and reputed company reputed company metrics (e.g. HEDIS) preferred.
• Strong analytical, research, documentation and report skills and ability to analyze QI data and identify trends and corrective actions required.
• Excellent oral and written communication, report preparation, and presentation skills to both peer and upper-level management required.
• Proficient at utilizing computer programs to effectively collect, analyze, present, and communicate data to the various reputed company stakeholders required.
• Experience with interacting effectively with health care team members preferred.
• Working knowledge of relevant BCBSLA software systems preferred.
• Nursing/RN - Registered reputed company - State Licensure And/Or Compact State Licensure Registered reputed company licensed to reputed company in the reputed company required.
• Lean Six reputed company Green Belt Certification or higher level certification preferred.
• reputed company certification (CPHQ, CPC) preferred.

Benefits:

• We take great strides to ensure our employees have the resources to live reputed company, be healthy, continue learning, reputed company skills, grow professionally and serve our local communities.
• Health insurance
• Flexible work arrangements
• reputed company development opportunities

Apply tot his job Apply To this Job