Quality Specialist (Hybrid)

CareFirst BlueCross BlueShield; Baltimore (MD); Hybrid; USD 48,168 - 95,667; Full time

Job summary

CareFirst BlueCross BlueShield is seeking an experienced professional in Baltimore/Washington for a position focused on promoting population health. This role requires delivering culturally appropriate health promotion information and includes hybrid work from home and at CareFirst locations.

Candidates should have a Bachelor’s degree and 3 years of relevant experience in public health or healthcare settings. The role involves member outreach, analyzing quality reports, and collaborating with healthcare providers to improve care outcomes.

The salary range for this position is $48,168 - $95,667, and candidates must be eligible to work in the U.S. without sponsorship.

Qualifications

• Minimum 3 years of experience in a business/public health environment.
• Experience in member and provider engagement is preferred.
• Certification in quality or process improvement methods desired.

Responsibilities

• Conduct member and provider outreach to close care gaps.
• Analyze claims data to improve member compliance.
• Collaborate with providers to manage member referrals for quality campaigns.

Skills

Engagement of health care consumers

Qualitative and quantitative data analysis

Healthcare claims knowledge

Fluency in Microsoft tools

Education

Bachelor’s Degree in relevant field

Tools

Microsoft Excel

Microsoft Word

Microsoft PowerPoint

Microsoft Outlook

Job description

Purpose

Utilizing the population health frameworks provided by NCQA Accreditation, HEDIS and CMS, this position is responsible for delivering culturally appropriate health promotion information to members that helps increase their access and reduce their barriers to preventive care, resulting in industry-leading outcomes at a population level. This role uses expertise in HEDIS, other technical quality measures, and advanced member engagement techniques to ensure improved population health and accreditation results.

We are looking for an experienced professional in the greater Baltimore/Washington metropolitan area who is willing and able to work in a hybrid model, with a portion of the week from home and a portion at a CareFirst location based on business needs.

Essential Functions

• Conduct member and provider outreach designed to close member gaps in care, documenting such efforts to facilitate collaboration with team members and other member‑facing care delivery staff.
• Analyze quality reports and claims data to assess up‑to‑the‑minute member compliance status for a variety of quality measures, using this information to improve compliance and member health outcomes.
• Collaborate with in‑home and community‑based providers to locate non‑compliant members, managing member referrals to those providers for various gap‑closing quality campaigns. Maintain access to provider reporting of gap‑closure outcomes and facilitate transmission of such information as supplemental data where allowed.
• Maintain ongoing subject‑matter expertise in population health, measurement science, accreditation, and quality improvement, utilizing the NCQA Accreditation, HEDIS & CMS quality standards framework to accomplish and document work products.

Qualifications

Education Level: Bachelor’s Degree in Population Health, Public Health, Healthcare Administration, Business Administration, Health Policy, Economics, Statistics, Mathematics, Data Science, or a related field. Or, in lieu of a bachelor’s degree, an additional 4 years of relevant work experience is required in addition to the required work experience.

Experience: 3 years of professional experience in a business environment (public health, health insurance, management consulting fields preferred); evidence of progressing levels of responsibility.

Preferred Qualifications

• Previous experience in member and provider engagement to influence behavior change and improve health outcomes.
• Certification in quality or process improvement methods.
• Direct experience with accreditation, HEDIS, CAHPS and other quality‑related activities within a healthcare or payor organization.

Knowledge, Skills, & Abilities (KSAs)

• Ability to engage health care consumers and/or health care providers in outcomes‑driven assessment, planning, and execution of improvement activities.
• Expertise in qualitative and quantitative data analyses and presentations.
• End‑to‑end experience designing, developing, and implementing innovative strategies to improve population health.
• Fluent in Microsoft tools, including Excel, Word, PowerPoint, and Outlook.
• Knowledge of healthcare claims, survey, clinical, and health data.
• Ability to meet deadlines and handle multiple customer service demands from internal and external customers while maintaining service excellence and positive communication, even with challenging customers.

Salary Range

$48,168 - $95,667

Salary Range Disclaimer: The disclosed range estimate has not been adjusted for geographic differentials associated with the location at which the work is performed. This compensation range is specific and considers factors such as scope and responsibilities of the position, the candidate’s experience, education/training, internal peer equity, and market and business considerations.

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. The policy of the Company is to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Discretion / Physical Demands

The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes them ineligible to perform work directly or indirectly on federal health care programs.

Physical demands: the associate is primarily seated while performing duties. Occasional walking or standing is required; hands are regularly used to write, type, and handle small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without sponsorship.