SUMMARY. The Manager, HEDIS Data & Analytics will oversee activities in support of HEDIS data management including HEDIS rate generation, oversight of the HEDIS vendor, collaboration with IT teams, and HEDIS audit support. This position is responsible to plan, organize, direct, control, and lead the assigned business unit. ESSENTIAL DUTIES AND RESPONSIBILITIES. Manages activities of a department including, but not limited to, planning, problem so...
SUMMARY. The Manager, HEDIS Data & Analytics will oversee activities in support of HEDIS data management including HEDIS rate generation, oversight of the HEDIS vendor, collaboration with IT teams, and HEDIS audit support. This position is responsible to plan, organize, direct, control, and lead the assigned business unit. ESSENTIAL DUTIES AND RESPONSIBILITIES. Manages activities of a department including, but not limited to, planning, problem so...
Our internship program is designed to enhance the skills and abilities of young professionals as well as to identify and attract future talent for our organization. Interns will gain practical hands-on work experience as well as a solid understanding of the health insurance industry. Our program is an excellent way for interns to get a good start on their careers by working on meaningful projects, learning valuable skills, and networking with emp...
SUMMARY. Responsible for projecting performance related to the CMS Star Ratings program using various statistical methodologies that include analyzing historical performance, incorporating industry knowledge and trends, and scenario modeling. This also includes collection and maintenance of monthly performance data, monthly dashboard reporting, and creation of PowerPoint presentations to share performance with clients. Additional ad-hoc analysis ...
SUMMARY. Support BCBSM and BCNA providers (pharmacists and physicians) with Medicare drug coverage inquiries, Grievances, and prior authorizations. RESPONSIBILITIES/TASKS. Answer telephones in an efficient and timely manner to lend appropriate assistance to providers. Process prior authorization requests under the supervision of a Clinical Pharmacist. Apply pharmacy prior authorization criteria used in the adjudication of pharmacy PA requests. An...
SUMMARY. The purpose of the Medicare Part D PGY1 residency program is to empower and educate the resident in all areas of Medicare Part D practice, including but not limited to. Formulary Management (including Rebates). Pharmacy and Regulatory Compliance and Audit. Pharmacy Benefits Management. Clinical Pharmacy Programs. Plan Performance and Quality Assurance. Medicare Part B and D Prior Authorizations and Appeals. Product Development. Administr...
SUMMARY. Join our Customer Experience team as a summer intern and gain hands-on experience in the healthcare industry, while contributing to initiatives that make a real difference in people's lives. As a member of our team, you'll have the opportunity to work on exciting projects that focus on improving member sentiment and care experiences while playing a key role in shaping the future of our customer experience strategy. Our team is committed ...
SUMMARY. This position is responsible for the Medication Adherence program for BCBSM senior members. The Director will design and execute a multi-year strategy that improves adherence rates and achieves Star measure performance goals. The Director will report to the Managing Director of Pharmacy Quality and oversee a large, multidisciplinary team of pharmacists, pharmacy technicians, data analysts, and external vendors. This role requires strong ...
SUMMARY. . The Stars Transformation Lead supports all aspects of the Medicare Stars program, advising on technical specifications, timelines, rules, and measures. They collaborate with owners in five Stars domains (HEDIS, Pharmacy, HOS, CAHPS, Operations) to set and track Key Performance Indicators (KPI’s) in a performance dashboard, update and monitor results, review portfolios for improvements, support meeting logistics, and manage projects as ...
Responsible for exercising discretion and judgment in assisting one or more executives. Performs executive support tasks which may be highly confidential and sensitive in nature utilizing considerable independent judgment. Performs high-level administrative work, including organizing, scheduling, coordinating, researching, compiling, and exchanging, and sometimes analyzing information for executive(s) and department. Assist in implementing depart...
Department Summary. This role drives performance and is responsible for meeting sales targets for individual Medicare Plus Blue PPO, BCN Advantage HMO, BCN Advantage HMO-POS, Blue Cross Medicare Supplement, and Prescription Blue PDP plans. The individual Medicare Sales team leads both growth and retention across all Medicare products. We oversee field sales, telesales, and partner distribution, while driving strategies for member conversion from ...
