Quality Improvement Coordinator (healthcare quality improvement/Medicare experience required)
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.
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.
- 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.
- Collaborates with internal stakeholders and committee chairpersons in the development, communication, and implementation of Quality Management or Improvement Committee decisions and/or corrective action plans.
- Builds and maintains 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.
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.
Skills / Requirements
Preferred Work Experience
- 4+ years 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 experience demonstrating tangible achievements and successes driving quality improvement initiatives with payers/managed care or physician-based teams;
- 3+ years analyzing and interpreting and communicating clinical, quality, and utilization data to identify gaps and opportunities, including developing workflows and presentations.
- Current knowledge of Medicare, NCQA or URAC accreditation processes.
- Master’s degree in healthcare administration, public health, nursing, social work or other health related field
Preferred Licenses and CertificationsLicensed 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.