Quality Improvement Specialist - Remote

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

· 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.

REQUIRED QUALIFICATIONS

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/health plan;

· 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

PREFERRED QUALIFICATIONS

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

· N/A

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, collogues, 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.

REQUIRED COMPETENCIES

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

new ideas;

· Excellent troubleshooting, analytic and problem-solving skills with the ability to seek out, 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 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

PREFERRED COMPETENCIES

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.

Our Commitment

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.