Job Description

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 remote work opportunity requires residency, and work to be performed, within the State of Arizona.


Oversees the training and field work of the Quality Improvement Team. This position is responsible for the training and supervision of Quality Improvement Team, who work with physician practices with opportunities for improved quality, risk adjustment and clinical workflow (referral management and population health management) performance.


1. Required Work Experience

· 5 years quality improvement and health management experience in a healthcare or managed care setting

2. Required Education

· Bachelor’s degree in healthcare administration, public health, nursing, social work or health related field

3. Required Licenses

· N/A

4. Required Certifications

· N/A


1. Preferred Work Experience

· 1 year of supervisory/management experience

2. Preferred Education

· N/A

3. Preferred Licenses

· LPN license

4. Preferred Certifications

· Medical Assistant certification or

· Coding (HCC/MRA) experience


· Works collaboratively with the Quality Improvement Team and practice staff to coordinate improvement efforts related

to overall performance.

· Coaches the Quality Improvement Team on the effective design and implementation of plans for continuous improvement and best practices within physician practices.

· Oversees the assessment of performance in relation to established goals and standards; participates in the recommendation of new approaches, policies, workflows, and procedures to effect continual progress toward goals

and standards.

· Implementation of performance improvement plans at the practice level.

· Oversees process improvement within physician practices that will drive or have a direct impact on process improvements and enhancing clinical workflows.

· Interacts with providers regarding billing and documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.

· Supports process improvement to enhance physician and staff workflow.

· Directly engages patients to ensure screening and other required preventative tests and appointments are completed.

· Works with laboratory and other vendors as required to collect patient results. · Works with practice Electronic Health Records or paper records to support Medicaid Business Segment reporting and monitoring of quality performance.

· Provides expertise to develop and sustain process improvements at all levels of the organization.

· Provides dashboard reports to providers and practices and recommendations on improvement.

· Maintain collaborative team relationships with peers and colleagues in order to effectively contribute to the working group's achievement of goals, and to help foster a positive work environment.

· Collaborates across functional departments to support and implement changes/enhancements.

· Provides leadership in planning, reporting, evaluating, and facilitating improvement processes to increase effectiveness and efficiency in contracted practices.

· Manages the development of effective communication methods to keep staff and others informed about improvement activities.

· Provides Medicaid Business Segment Performance Operations and practice staff with appropriate level of clinical training relative to performance measures including but not limited to spirometry, ABIs, taking and recording a blood pressure, urine collection and diabetes in-office testing.

· Assists in preparation of training materials (internal or external).

· Provides virtual and on-site education and guidance.

· 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


1. Required Job Skills

· Familiarity and understanding of CMS HCC Risk Adjustment coding and data validation requirements

2. Required Professional Competencies

· N/A

3. Required Leadership Experience and Competencies

· N/A


1. Preferred Job Skills

· Experience with HEDIS and/or process improvement

2. Preferred Professional Competencies

· N/A 3. Preferred Leadership Experience and Competencies · N/A

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  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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