Quality Management Leader - HEDIS & Stars Programs

Horizon Blue Cross Blue Shield; Newark (NJ); Hybrid; USD 110,000 - 150,000; Full time

Job summary

Horizon Blue Cross Blue Shield of New Jersey in Newark, NJ, is seeking a Manager of Quality Management to lead Clinical Operations, Audit, and Performance Reporting, including HEDIS and STARS, for Horizon Government Programs. The role directs teams, develops policies, and collaborates with senior leadership to drive quality improvements in a complex healthcare environment.

The ideal candidate has a Bachelor's degree, at least five years in healthcare quality and five years in management, with

Qualifications

• Requires a Bachelor's degree in a related field and at least five years in healthcare quality management.
• Minimum five years in a health plan, hospital, or managed care setting.
• Minimum five years of management experience and strong leadership skills.
• Experience with HEDIS, CAHPS, and Medicare Stars knowledge.

Responsibilities

• Directs staff to support quality improvement initiatives in QA, HEDIS, and Stars.
• Develops policies and procedures to improve quality and accreditation readiness.
• Represents the department with internal stakeholders and external agencies.
• Oversees performance reporting and ensures regulatory compliance.

Skills

Leadership

Project management

Quality improvement

Analytical thinking

Cross-functional collaboration

Education

Bachelor's degree

Master's degree preferred

Tools

MS Office

Job description

Horizon Blue Cross Blue Shield of New Jersey in Newark, NJ, is seeking a Manager of Quality Management to lead Clinical Operations, Audit, and Performance Reporting, including HEDIS and STARS, for Horizon Government Programs. The role directs teams, develops policies, and collaborates with senior leadership to drive quality improvements in a complex healthcare environment.

The ideal candidate has a Bachelor's degree, at least five years in healthcare quality and five years in management, with