Quality Management Audit 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.
This position is remote within the state of AZ only. This remote work opportunity requires residency, and work to be performed, within the State of Arizona.
Purpose of the Job
This position supports quality management functions for the Health Choice Arizona managed care organization. This position provides leadership of provider oversight and monitoring throughout the provider network, for both behavioral health care and physical health care. The position monitors, reviews and improves quality of care provided to members.
Required Work Experience
- 7 years of healthcare experience including quality management and performance improvement
- 3 years supervisory experience of professional staff
- Bachelor’s Degree in healthcare related field
- Valid Arizona Driver License, with an acceptable driving record
Preferred Work Experience
- Master’s Degree in healthcare related field
- Certified Professional in Healthcare Quality (CPHQ)
Essential Job Functions and Responsibilities
- Manages a work unit responsible for oversight of provider quality of care and documentation standards.
- Collaboration with accreditation bodies and regulators to ensure compliance with requirements.
- Develops and implements annual quality management provider auditing plans.
- Analyzes and evaluates clinical documentation for systemic trends and leads improvement projects.
- Ensures improvements are achieved in the clinical care provided by contracted providers.
- Provides leadership to AHCCCS QM deliverable development related to provider monitoring, Performance Improvement Projects, and QM Work Plan Goals.
- Ensures providers are in compliance with contractual obligations, the provider policy manual and other federal and state behavioral health regulations.
- Collaborates with internal departments, including Quality Management, Performance Improvement and Quality Analytics on performance measurement to ensure data integrity.
- Supervises employees performing performance improvement and provider oversight 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 referral sources to identify and respond to trends and/or emerging issues and to ensure compliance with minimum standards.
- Leads and conducts Health and Safety visits to providers’ offices.
- Manages regulatory requirements related to medical record review audits including work group participation, tool development, auditor training, trend analysis and oversees provider action plans.
- 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 may be required.
- Perform all 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
- Subject Matter Expertise with PDSA improvement methodologies.
- Proficiency in developing and presenting analytic reports (written and verbal), data collection, sampling, analysis and presentation.
Required Professional Competencies
- Time Management
Required Leadership Experience and Competencies
Preferred Job Skills
Preferred Professional Competencies
Preferred Leadership Experience and Competencies
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.