Medicare Quality Improvement Coordinator-3 yrs exp in Medicare Quality Improvement
Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.
Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering 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.
This Medicare Quality position will analyze, develop and implement metrics for quality improvement initiatives. We are looking for experience in.. data analysis to comply with Medicare QI surveillance and reporting requirements.
The Quality Improvement (QI) Coordinator is responsible for developing and executing the continuous quality improvement program, in accordance with the mission and strategic goals of the Company, federal and state laws/regulations, accreditation standards, and specific contractual requirements. The QI Coordinator supports the optimization of quality improvement strategies through the identification and execution of initiatives focused on supporting and improving the quality improvement infrastructure, tools, and key performance metrics, resulting in improved operational and program efficiencies and effectiveness. The QI Coordinator performs QI activities in accordance with Continuous Quality Improvement (CQI) principles and the Plan, Do, Study, Act (PDSA) methodology.
Required Work Experience
- 3 years of healthcare quality or performance improvement and/or health/disease management experience in a healthcare, physician practice, or managed care setting;
- 2 years of experience analyzing and interpreting clinical, quality, and/or utilization data to identify gaps and opportunities in healthcare quality.
- 2 years of Medicare experience.
- Bachelor’s degree in healthcare administration, public health, nursing, social work or health related field
Preferred Work Experience
- 4 years of healthcare quality/performance improvement and/or health/disease management experience in a healthcare, physician practice, or managed care setting, with at least 2 years facilitating quality/performance improvement initiatives among cross-functional teams;
- 2 years of experience demonstrating tangible achievements and successes driving quality improvement initiatives with payers/managed care or physician-based teams;
- 3 years of analyzing and interpreting and communicating clinical, quality, and utilization data to identify gaps and opportunities, including developing workflows and presentations.
- Master’s degree in healthcare administration, public health, nursing, social work or other health related field
Preferred Licenses and Certifications
- Licensed Registered Nurse, Licensed Practical Nurse or Licensed Clinical Social Worker; Utilization Management and/or Case Management certification; or, Certified Professional in Healthcare Quality (CPHQ) certification.
ESSENTIAL job functions AND RESPONSIBILITIES
- Lead, assist and/or coordinate projects as directed by the Quality Department, Quality Governance Committees (QIC, QMC) and other interdepartmental teams (e.g., Status reports for Medical Management Committee, Quality Committee and/or Board of Directors as indicated).
- Use PDSA, CQI principles, or lean methodology and tools to conduct quality improvement initiatives, e.g., driver diagrams, decision trees, root cause, workflow development.
- Analyze, develop, implement and monitor quality improvement initiatives to achieve quality outcomes; may include identifying and coordinating the collection of key data sets to support the improvement and the evaluation of designated quality initiatives.
- Support medical record data review/collection as it relates to the quality improvement strategy and goals, including contractual & regulatory obligations.
- Provide ongoing monitoring & assessment against goals and key performance indicators, evaluating & identifying trends or opportunities for improvement; this includes identifying, collecting, validating, and analyzing data and reporting on trends & performance standards aligned with the departmental performance reports & expectations;
- Participate in development and/or revision of program descriptions, work/evaluation plans, policies & procedures, and other key documentation as needed;
- Perform vendor oversight activities such as, but not limited to, attending routine meetings and tracking project/status and coordinating action plans, assignments and timelines, monitoring vendor services against service level agreement(s) & contract requirements, collaborating with Procurement on contract development and maintenance.
- Collaborate with internal stakeholders and committee chairpersons in the development, communication, and implementation of Quality Management or Improvement Committee decisions and/or corrective action plans.
- Build and maintain collaborative relationships with key internal and external stakeholders to coordinate and advance quality improvement opportunities, achieve goals & objectives, and foster a positive work environment.
- Perform duties and functions to comply with quality program requirements and State, Federal, FEP, BCBSAZ, the BCBS Association and other applicable regulatory/accrediting agency standards as they apply to department functions.
- Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals.
- Performs other duties as assigned.
- The position 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.
Required Job Skills
- Advanced Proficiency with Microsoft office suite applications including:
- Intermediate Excel and PowerPoint
- Ability to use video conferencing and online collaborative tools (e.g., MS Teams, SharePoint)
- Ability to effectively use dual monitors
- Ability to quickly learn and understand CMS regulatory and contractual documents, including corporate policies & procedures
- Knowledge of Medicare, URAC and/or NCQA accreditation standards
- Intermediate data analysis skills (e.g., sort, filter, pivot to ID trends or outliers)
Required Professional Competencies
- Exudes excellence by setting high standards of performance for self and all coworkers, demonstrates low tolerance for mediocrity, requires high-quality results and exhibits conscientiousness and high sense of responsibility.
- Stimulates creativity with the ability to see broadly outside the typical status quo and is constantly open to and promotes new ideas.
- Excellent trouble-shooting, analytic and problem-solving skills with the ability to create and communicate effective solutions.
- Ability to be organized and manage multiple tasks simultaneously in a demanding, fast-paced environment while keeping relevant others in the organization informed of progress and/or obstacles.
- Ability to successfully work with minimal supervision, seeks out and seizes opportunities, finds ways to surmount barriers, and takes lead roles in working with key stakeholders and other analysts.
- Shares important and relevant information with the team. Proactively offers suggestions, provides resources, volunteers for assignments, and removes barriers to help the team accomplish its goals.
- Excellent writing skills with the ability to compose and deliver a variety of business correspondence.
- Excellent verbal skills including ability to present to a variety of audiences.
- Ability to build trusting relationships and maintain confidentiality and privacy.
- Demonstrate effective interpersonal and active listening skills to achieve customer satisfaction and support departmental communication standards.
- Current knowledge of Medicare, NCQA or URAC accreditation processes.
Required Leadership Experience and Competencies
- Superior ability to effectively engage various audiences under a variety of fast-paced and high profile circumstances, orally and in writing.
- Experience communicating with a high level of discretion and professionalism with physician leaders/office staff, executives and other stakeholders.
- Ability to independently manage technical/complex, multi-staged projects from beginning to end.
- Ability to leverage available information and opportunities to develop and maintain the project’s scope, identify and align priorities, and mitigate competing priorities and scope creep.
- Be Blue: professionally represent BCBSAZ in the community.
Preferred Job Skills
- Knowledge and experience working with Microsoft Project
- Advance Excel, Tableau, Whyzen or database skills
- Six Sigma, Lean Master knowledge and/or certification
- Knowledge of common health plan data & coding attributes like CPT-4, HCPCS, Hierarchical Condition Category (HCC), ICD-10 coding, SNOMED, etc.
Preferred Professional Competencies
- Excellent time/project management skills, ability to work independently and meet deadlines/expectations; providing management with status updates pertinent to quality and performance improvement programs.
- Ability to understand and accurately communicate comprehensive analytic results, complex regulatory, and technical documents (e.g., regulations, contracts, performance measure technical specifications) to a variety of internal and external audiences. Public speaking and group presentation skills.
- Self-starter, resourceful and able to execute projects in a fluid and fast paced environment.
Preferred Leadership Experience and Competencies
- Demonstrated ability to facilitate cross-functional teams, including mitigating team conflict and/or challenges.
BCBSAZ 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.
Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross® BlueShield® of Arizona