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Responsible for the management of Clinical Data Integration initiatives and integration activities. Responsible for managing strategic, multiple complex, cross-boundary projects, services and associated deliverables related to data analysis activities in support of FEP objectives. In addition, this function provides leadership through the IPAG in assisting and guiding Plan analytic staff with care coordination implementation and care management initiatives. This function is also the business leadership in managing and organizing staff in promoting appropriate use of FEP analytic tools for both Plan users as well as internal FEP users. This function will act as a senior internal consultant in the identification, implementation, and/or development of clinical, quality, and financial analytical models to demonstrate value and or increase the value of services for Plans and internal customers. This function will manage key strategic initiatives, complex projects, and function as a strategic and technical resource as well as a subject matter expert.
- Represents department and FEP on internal and external groups, as assigned. Build/maintain excellent relationships with internal and external business partners and/or customers. Serve as a liaison or contact between FEP analytics and key customers. Serves as an ongoing conduit of information from customers to aooropriate BCBSA staff.
- Oversees and/or conducts formal market assessments of best practices in the health industry addressing the management and use of healthcare information and determines the business value and practicability for FEP. Identifies issues and recommends initiatives to address data quality and data integrity. Conducts a myriad of complex analyses, interprets findings, and develops recommendations and/or strategies to meet FEP and BCBSA core objectives. May lead or participate on team to take recommendation to implementation.
- Manages and provides leadership for FEP Clinical Data Integration. Activities with primary focus on HEDIS processes and outcomes. Manages clinical data and governance initiatives in support of. Integrated Care Management and other FEP departments. Performs various assessments and identifies opportunities for process/systems improvement.
- Oversees and significantly contributes to the execution of complex projects and deliverables that cross many functional boundaries. Provides oversight and guidance in the resolution of complex issues utilizing available resources and expertise in support of division budget and objectives. Provides project oversight in the ollection, analysis, synthesizes of FEP benefit cost data. Accesses complex data, models and databases, and utilizes survey instruments, information resources, or other research methodology.
- A minimum of ten years of experience within a business environment with a minimum of 7 years within a managed care or health services delivery setting with expertise in health care operations, claims processing, provider contracting, benefit cost containment programs and healthcare informatics
- College degree with a health care concentration preferred (or equivalent health care experience)
- Registered Nurse
Company: Blue Cross Blue Shield Association
Vacancy Type: Full Time
Job Location: Columbia, SC, US
Application Deadline: N/A