Hybrid Quality Operations Director - HEDIS & Analytics

CareFirst BlueCross BlueShield; Baltimore (MD); Hybrid; USD 143,000 - 265,000; Full time

Job summary

CareFirst BlueCross BlueShield in Baltimore, MD is seeking an experienced leader to plan, organize, and drive enterprise quality performance across health plan populations. Develop and execute data acquisition, quality analytics, and multi-year quality improvement strategies that enhance member outcomes, customer satisfaction, and quality of care.

The incumbent will oversee quality vendor management, medical record retrieval and validation, accreditation support, regulatory and state reporting,

Qualifications

• Bachelor's Degree in business administration, health policy, health services research, public health, economics, mathematics, computer science, or a related field.
• 8 years experience in a healthcare, public health, health insurance, quality/process improvement or data management business environment
• 3 years management experience

Responsibilities

• Directs day-to-day prioritization of work for quality analysts, data engineers, and quality operations staff.
• Leads enterprise HEDIS strategy, submission activities, and roadmap execution across lines of business.
• Drives quality analytics, trend analysis, and reporting frameworks to improve Stars ratings and regulatory compliance.
• Maintains knowledge of NCQA, CMS/Federal, and state requirements; participates in committees and workgroups.
• Oversees department operations, budgeting, and development of high-performing teams.

Skills

Leadership

Data analytics

Quality improvement

Regulatory compliance

Vendor management

Public speaking

Team leadership

Education

Bachelor's Degree (business ADMIN/health policy/health services research/public health/economics/mathematics/computer science)

Tools

Microsoft Office

Job description

CareFirst BlueCross BlueShield in Baltimore, MD is seeking an experienced leader to plan, organize, and drive enterprise quality performance across health plan populations. Develop and execute data acquisition, quality analytics, and multi-year quality improvement strategies that enhance member outcomes, customer satisfaction, and quality of care.

The incumbent will oversee quality vendor management, medical record retrieval and validation, accreditation support, regulatory and state reporting,