Quality Improvement Specialist (Medicaid)
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.
For Internal Use Only:
PURPOSE OF THE JOB
The QI Specialist supports quality improvement team operations and activities to ensure achievement of the overall QI Program objectives and goals. Includes responsibility for collecting, analyzing data & information needed to support the
development, implementation, and evaluation of programs, which may require learning various platforms and digital tools.
The QI Specialist performs QI activities in accordance with effective quality improvement methods and principles such as Continuous Quality Improvement, Lean Six Sigma, and Plan, Do, Study, Act.
1. Required Work Experience
· Minimum 2 years healthcare quality or performance improvement and/or health/disease/population management with
at least 1 year of experience in a physician practice, or managed care/healthplan;
· Minimum 1 year collecting and analyzing quality-related data sets to support quality reporting.
2. Required Education
· Bachelor’s degree in healthcare administration, public health, social work or health related field; Alternatively, having the "Preferred Work Experience" as described below may be considered in lieu of required education.
3. Required Licenses
4. Required Certifications
1. Preferred Work Experience
· 3+ years healthcare quality management, performance improvement, and/or health/disease/population management
experience in a healthcare, physician practice, or managed care;
· 2+ years collecting, analyzing, and reporting on quality-related data sets.
2. Preferred Education
* Master’s degree in healthcare administration, public health, social work or other health related field
3. Preferred Licenses
4. Preferred Certifications
* Certified Professional in Healthcare Quality (CPHQ)
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
- Assess, collect, analyze data needed to support quality improvement initiatives and activities including data related to the measurement and improvement of the Healthcare Effectiveness Data and Information Set (HEDIS®) and annual Quality work plans.
- Participate and support the development and execution of activities supporting the Quality Program Descriptions, Workplans, and evaluations, policies and procedures, including corporate and QI team expectations.
- Inventory, assess, execute annual updates of desktop procedures and other processes for the Quality Improvement team, may include using QI tools such as process mapping, driver diagrams, and other workflow/improvement tools.
- Partner with the QI Coordinators to support the development, execution, and evaluation of Quality Improvement projects and activities, e.g., as described in the Program Descriptions, Workplans, including executing recommendations through the quality reports at various quality committees.
- Support the execution of quality improvement initiatives and/or corrective action plans with relevant QI Coordinator and business teams across the organization and as recommended through the Quality Management Committees;
- Working knowledge of URAC to support maintaining a status of ‘audit readiness’ as it pertains to the relevant quality-related standards and in conjunction with the QI Coordinators who oversee the Quality Programs.
- Support medical record data review/collection as it relates HEDIS measurement and gap closure; may include support of an enterprise medical record repository.
- Support vendor oversight activities such as but not limited to monitoring compliance with service level agreements and confirming accuracy of vendor invoicing.
- Builds and maintains collaborative relationships with key internal and external stakeholders, peers, collegues, and leaders 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, 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.
- Perform 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.
1. Required Job Skills
* Demonstrated proficiency with Microsoft office suite applications including:
* Intermediate Excel data analysis skills (e.g., sort, filter, pivot to ID trends or outliers)
* Intermediate PowerPoint skills;
* Ability to learn and use video conferencing (e.g., MS Teams) and online collaborative tools (e.g., 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 Advantage, URAC, and/or NCQA accreditation standards, including HEDIS.
2. 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
* Excellent trouble-shooting, analytic and problem-solving skills with the ability to seek out, create, and communicate
* 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 process and evaluate complex data and information sets
* Ability to successfully work independently 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 written and verbal skills including ability to compose a variety of business correspondence
* Ability to build trusting, professional relationships and maintain confidentiality and privacy
* Demonstrate effective interpersonal and active listening skills to achieve internal/external customer satisfaction and
support departmental communication standards.
3. Required Leadership Experience and Competencies
* Ability to effectively engage various audiences;
* Ability to support and/or 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
1. 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.
2. Preferred Leadership Experience and Competencies
* Demonstrated ability to facilitate cross-functional teams.
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