Manager, Performance/Quality Improvements - HYBRID

Blue Cross Blue Shield of Arizona; Phoenix (AZ); Hybrid; USD 90,000 - 120,000; Full time

Job summary

Blue Cross Blue Shield of Arizona is seeking a Quality Improvement professional to manage NCQA HEDIS and related quality metrics within Arizona. The role oversees system-wide improvement projects, corrective action plans, and data integrity across QA and analytics teams.

The position requires 5 years in health care payer/provider space, a Bachelor's degree, and certification such as CPHQ or CHCQM. Hybrid work in AZ with onsite expectations of 2 days/week, and potential travel to AHCCCS and

Qualifications

• Work Experience: 5 years in the health care payer or provider space.
• Education: Bachelor’s Degree.
• Licenses: N/A
• Certifications: CPHQ or CHCQM.

Responsibilities

• Responsible for driving performance improvement for NCQA HEDIS and other quality metrics.
• Develops and implements system-wide performance improvement projects.
• Development and monitoring of Corrective Action Plans for effectiveness in achieving performance targets.
• Collaborates with internal departments including Quality Management, Performance Improvement and Quality Analytics on NCQA HEDIS performance measurement to ensure data integrity.
• Supervises employees performing performance improvement and monitoring functions.
• Reports quality improvement and performance outcomes to leadership, regulatory bodies and stakeholders.
• Analyzes data and communicates results and recommendations with internal and external staff and provider agencies.
• Monitors and tracks provider performance and data from multiple sources to identify trends and emerging issues and to ensure compliance with minimum standards.
• Utilizes data to develop intervention strategies to improve outcomes and reports quality improvement and performance outcomes as requested to ensure ongoing compliance with contractual requirements.
• Conducts research, reviews, analyzes and compiles data, develops recommendations and reports.
• Some travel is required to attend meetings with AHCCCS, provider agencies and other meetings as assigned.
• The position has an onsite expectation of 2 days per week and requires a full-time work schedule (40+ hours per week).
• Perform all other duties as assigned

Skills

NCQA HEDIS

CMS Core measures

Medicaid MCO

Analytical reporting

Problem solving

Stakeholder collaboration

MS Office

Data confidentiality

Leadership experience

Strategic program mgmt

Education

Bachelor’s Degree

Master’s Degree (preferred)

Job description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
• Onsite: daily onsite requirement based on the essential functions of the job
• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is hybrid within the state of AZ only.

This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

Purpose of the Job

The position is responsible for managing Quality Improvement activities as well as staff conducting quality improvement work as outlined in AHCCCS contract and policy for the Medicaid Segment. This position and staff reporting to this position shall reside in Arizona within the Geographical Service Area for contract compliance, have knowledge of both physical and behavioral health service delivery, monitor, review and evaluate performance measure data and technical specifications. The employee holding this position shall not hold any other position within the organization.

Qualifications

Required Qualifications

• Work Experience: 5 years experience in the health care payer or provider space
• Education: Bachelor’s Degree
• Licenses: N/A
• Certifications: CPHQ through the National Association for Health Care Quality (NAHQ) or is a CHCQM through the American Board of Quality Assurance and Utilization Review Physicians

Preferred Qualifications

• Work Experience: 10 years healthcare experience, within the Arizona Medicaid system preferred
• Experience leading system-wide interdisciplinary improvement projects
• Education: Master’s degree in business, healthcare administration or healthcare related field
• Licenses: N/A
• Certifications: N/A

Essential Job Functions and Responsibilities

• Responsible for driving performance improvement for National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) and other quality metrics
• Develops and implements system-wide performance improvement projects
• Development and monitoring of Corrective Action Plans for effectiveness in achieving performance targets and reporting on effectiveness of recommended actions
• Collaborates with internal departments including Quality Management, Performance Improvement and Quality Analytics on NCQA HEDIS performance measurement to ensure data integrity
• Supervises employees performing performance improvement and monitoring functions
• Reports quality improvement and performance outcomes to leadership, regulatory bodies and stakeholders
• Analyzes data and communicates results and recommendations with internal and external staff and provider agencies
• Monitors and tracks provider performance and data from multiple sources to identify and respond to trends and or emerging issues and to ensure compliance with minimum standards
• Utilizes data to develop intervention strategies to improve outcomes and reports quality improvement and performance outcomes as requested to ensure ongoing compliance with contractual requirements
• Conducts research, reviews, analyzes and compiles data, develops recommendations and reports
• Some travel is required to attend meetings with AHCCCS, provider agencies and other meetings as assigned
• The position has an onsite expectation of 2 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other duties as assigned

Competencies

Required Competencies

• Subject matter expertise with NCQA HEDIS and CMS Core performance measure calculation and data collection methodologies
• Experience with Medicaid managed care organizations
• Proven record of accomplishment working with executives across a multi-layered organizational platform
• Proficiency in developing and presenting analytic reports including written and verbal communication, data collection, sampling, analysis and presentation
• Excellent analytical and problem solving skills
• Ability to establish trust with all levels of stakeholder groups
• Exceptional interpersonal, influence, collaboration and listening skills
• Strong written communication skills including ability to use Microsoft applications such as MS Project, Word, Excel and PowerPoint
• Ability to maintain confidentiality, privacy and security of protected information
• Required Professional Competencies
• Strategic and consultative approach to program management
• Strong analytical skills with ability to quickly identify issues, root causes and solutions
• Ability to make decisions confidently and work independently
• Flexible and willing to adjust to changing priorities
• Required Leadership Experience and Competencies
• Confidence working with all levels of the organization and external partners
• Collaborative and motivational leadership style across multiple teams
• Ability to handle sensitive and confidential situations with professionalism and diplomacy

Preferred Competencies

• Advanced PC proficiency with word processing, spreadsheets and presentation software
• Experience with Daptiv preferred

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.