Clinical Quality Administrator (Hybrid)

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a 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.

Prosano Background/Purpose of the job

Prosano Health Solutions, in partnership with Blue Cross Blue Shield of Arizona, launched an Advanced Primary Care model, exclusively to Blue Cross and Blue Shield Members, available through Employers who offer the BlueSignature benefit to their team members.  Our mission is clear: To Inspire Health and Make it Easy.  Our goal is to deliver affordable, convenient, and personalized care to the communities we serve. Our Advanced Primary Care model is focused on providing a signature patient experience which will raise the bar in both the delivery of care, and by ensuring health equity is top of mind. In every market we serve, our goal is to bring to the community a customized, high-value system of care that is available for our members. Together, we will set the standard for how healthcare can and should be delivered in our State.

The Clinical Quality Improvement Specialist supporting Prosano Health Solutions will establish, document and implement an ongoing quality management program to evaluate incidents, collect data, and evaluate services provided during patient care.

Qualifications

REQUIRED QUALIFICATIONS

Required Work Experience

• 2 years of experience in Healthcare Quality Management
• 3-5 years of experience in a clinical healthcare care setting
• 3 years of performance improvement/quality assurance experience

Required Education

• Bachelor’s degree in healthcare administration, public health, nursing, social work or health related field

Required Licenses

• Valid Arizona Driver License

Required Certifications

• Certified Professional in Healthcare Quality (CPHQ) or other quality-related certification

PREFERRED QUALIFICATIONS

Required Work Experience

• 2 years of experience in Healthcare Quality Management
• 5 years of experience in a clinical healthcare care setting
• 3 years of performance improvement/quality assurance experience

Required Education

• Bachelor’s degree in healthcare administration, public health, nursing, social work or health related field

Required Licenses

• Valid Arizona Driver License

Required Certifications

• Certified Professional in Healthcare Quality (CPHQ) or other quality-related certification

ESSENTIAL job functions AND RESPONSIBILITIES

• Analyzes and evaluates data to identify trends in quality-of-care concerns, clinical incidents, and member complaints. Manage aspects that measure, monitor, and improve the quality of the care and service provided to our members
•  Manage the day-to-day oversight of clinical incidents and service recovery
• Facilitate and drive the following initiatives: Quality Assurance/Performance Improvement (QAPI) Committee and Quality Management Program for Prosano Health Solutions
• Identify trends, drive root cause analysis, create performance improvement plans and identify projects related to quality assurance.
• Demonstrate the ability to document information, update goals and quality plans, create appropriate Desk Level Procedures (DLPs), etc.
• Identify performance improvement projects which could be systemic issues requiring correction
• Maintains and tracks performance improvement activities and deliverables to confirm that the changes brought about through performance improvement activities are maintained
• Effectively collaborate with Prosano’s Clinical Compliance Officer while overseeing regulatory compliance with regulatory entities.
• Participate in evaluation of program’s effectiveness both from an internal plan and external provider practice perspective as determined by management
• Ability to work with executive leadership in a professional and collaborative role
• Working hours can include morning, night or weekend hours
• The position requires a full-time work schedule defined as working at least 40 hours per week, plus any additional hours as needed to meet business requirements
• This position requires 100% on site work at care center locations
• Perform all other duties as assigned

competencies

REQUIRED COMPETENCIES

Required Job Skills

• Advanced Proficiency with Microsoft office suite applications
• Strong organizational skills
• Strong written and verbal communications
• Strong PC proficiency

Required Professional Competencies

• Demonstrated flexibility in responding to the needs of multiple constituencies

• Demonstrated ability to lead and facilitate interdisciplinary teams
• Demonstrated skill in problem analysis, project management, conflict resolution and oral/written presentation
• Ability to balance and manage multiple projects
• Interpersonal skills that allow for harmonious relationships with providers, members and coworkers

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.