Job Description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers 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 Sr. Manager MA & FEP Quality Improvement Programs will plan, organize, direct and implement programs that support the organizational goals:

1. 4 Star Medicare Advantage performance and

2. FEP Performance Improvement Program (PIP) achievement.

This position will lead a team responsible for program strategy and initiative development across HEDIS, Pharmacy, Operations, CAHPS, HOS and improvement measures. The Sr. Manager will coordinate the Program Governance Framework across Executive Oversight Committee to Category Lead workgroups. Key activities include optimization of improvement strategies through the identification and execution of initiatives focused on supporting and improving the Program infrastructure, tools, and key performance metrics, resulting in 4-star performance across all MA contracts.  Exceptional skills in developing team member skill sets, relevant relationships, promoting positive professional communications, motivating members to improve health, and working with provider partners and vendors on innovative solutions. This position will support development and delivery of ongoing education to providers on the Stars Program strategy and performance as well as coordinate discussions with key provider partners on their external programs supporting Star improvement.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

Required Work Experience

  • 8 years of healthcare quality or performance improvement experience
  • 5 years of leadership experience
  • 5 years of experience in CMS Star Ratings (MA); Quality, Customer Service, and Resource Use Program (FEP); or Quality Rating System (ACA) Program. With experience including program performance, measurement, analytics, reporting and forecasting
  • 5 years of  Government Business experience.

Required Education

  • High School Diploma or GED

Required Licenses

  • N/A

Required Certifications

  • N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

  • N/A

Preferred Education

  • N/A

Preferred Licenses

  • N/A

Preferred Certifications

  • N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

  • Serves as and leads a team of  program subject matter experts for the Stars and FEP Quality Improvement Program across all key categories of measures (HEDIS, Pharmacy, Operations, CAHPS, HOS, Improvement).  Provide insight and analysis on trends for proactive strategies at entity and provider level
  • Accomplishes department objective by managing staff; planning, implementing, and evaluating initiatives; reporting key performance metrics
  • Maintains staff by recruiting, selecting, orienting and training best practices
  • Leads program regulation and technical specification reviews and comments within required timelines
  • Collaborates with vendor and provider partners to develop Star roadmap and identify protocols for co-brandings, reporting and member engagement
  • Develops and maintains relationships with provider partners to develop short and long term strategies on the advancement of Star measures and interventions for members
  • Works with internal and vendor based analytic platforms to identify opportunities for improvement, gap closure and facilitates efforts to implement processes and process change to promote positive advances
  • Creates and maintains tracking and reporting system that documents key performance metrics and provides mechanism for evaluation of activities coordination and effectiveness related to the Star Program
  • Provides comprehensive analysis of Star measures, barriers, and opportunities and present results of improvement efforts and ongoing performance measures to Health Plan leadership
  • Creates presentations and/or reports for senior management involving significant analysis of multiple or complex data sources. Co-Chairs Stars Executive Oversight Committee with Vice President as part of the Stars Governance and acts as coordination point for all other category committees impacting Stars. 
  • Collaborates with other leaders to research and analyze opportunities for Star improvement across provider and member facing activities
  • Lead regular project meetings to discuss project status, problems, teamwork, etc. and alerts sponsors to problems or risks that may jeopardize program success. Provides recommendations to mitigate.  Escalates when barriers exist.
  • 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. 
  • Performs all other duties as assigned

COMPETENCIES

REQUIRED COMPETENCIES

Required Job Skills

  • Advanced knowledge of Government Business including Medicare and/or Federal Employee Programs, NCQA, CMS Star, FEP QCR and/or ACA QRS standards. Experience working in strategy development and implementation, analytical and Quality-based process improvement in the health care health insurance sector
  • Advanced Proficiency with Microsoft office suite applications including: Microsoft Excel, PowerPoint, Word, Outlook
  • Ability to quickly learn and understand CMS regulatory and contractual documents, including corporate policies & procedures
  • Excellent analytical and problem-solving skills
  • Excellent writing skills with the ability to compose and deliver a variety of business correspondence.
  • Excellent verbal skills including ability to present to a variety of audiences.
  • Ability to build trusting relationships and maintain confidentiality and privacy.

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 trouble-shooting, analytic and problem-solving skills with the ability to 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 successfully work 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.
  • Demonstrate effective interpersonal and active listening skills to achieve customer satisfaction and support departmental communication standards.

Required Leadership Experience and Competencies

  • Strong leadership skills with proven ability to lead change to accommodate evolving organizational and regulatory processes
  • Excel in people management:  recruitment, selection, appraisals, address performance issues
  • Foster innovation: efficient processes, products and improved customer services
  • Change Management: prepare, support, and guide teams through organizational and program changes

PREFERRED COMPETENCIES

Preferred Job Skills

  • N/A

Preferred Professional Competencies

  • N/A

Preferred Leadership Experience and Competencies

  • N/A

Our Commitment

AZ Blue 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.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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