Quality Improvement Program Manager
Awarded the Best Place to Work 2021, 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.
PURPOSE OF THE JOB
This position supports performance measure monitoring and improvement functions for the Medicaid Segment’s managed care organization. This position will oversee performance measures throughout the organization and provider network for both behavioral health care and physical health care. The position monitors, reviews and evaluates performance measure data and technical specifications. This position is required to reside in the state of Arizona within the Geographical Service Area for contract compliance.
1. Required Work Experience
· 5 years’ experience in the health care payer or provider space
2. Required Education
· Bachelor’s Degree
3. Required Licenses
4. Required Certifications
1. Preferred Work Experience
· 10 years’ healthcare experience, within the Arizona Medicaid system preferred
· Experience leading system-wide interdisciplinary improvement projects
2. Preferred Education
· Master’s degree in business, healthcare administration or healthcare related field
3. Preferred Licenses
4. Preferred Certifications
· Certified Professional in Healthcare Quality (CPHQ) or CHCQM by the American Board of Quality Assurance and Utilization Review Physicians preferred
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/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 multiples 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/performance outcomes as requested to ensure on-going 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 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.
1. Required Job Skills
· 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 (written and verbal), data collection, sampling, analysis, and presentation.
· Excellent analytical and problem-solving skills
· Establishes trust with all levels of stakeholder groups
· Exceptional interpersonal skills, influence, collaboration and listening skills
· Strong written communication skills including the ability to leverage Microsoft applications including MS Project, Word, Excel, PowerPoint Knowledge
· Ability to maintain confidentiality, privacy, and security of protected information.
2. Required Professional Competencies
· Strategic, consultative approach to program management
· Strong analytic skills with an ability to quickly identify issues, root cause and solutions
· Confident to make decisions and work independently
· Flexible and willing to adjust to changing priorities
3. Required Leadership Experience and Competencies
· Confidence work with all levels of our organization and external organizations
· Collaborative, motivational style working with multiple organizational areas and teams
· Ability to handle sensitive and confidential situations with poise and diplomacy
1. Preferred Job Skills
· Advanced PC proficiency and skill in word processing, spreadsheets, and presentation software and use of
Daptiv is preferred
2. Preferred Professional Competencies
3. Preferred Leadership Experience and Competencies
Comply with BCBSAZ corporate and departmental policies and procedures, including, but not limited to Code Blue, Compliance, HIPAA, Computer Responsibility, Accreditation Standards, Attendance, Staff Qualifications, and Quality Management Accountabilities.
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.