Quality Improvement Coordinator (health plan quality improvement-HEDIS experience), Phoenix, AZ
Job Title Quality Improvement Coordinator (health plan quality improvement-HEDIS experience)
Job ID 4990
Full/Part Time Full-Time
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 1,400 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.
Responsible for analyzing data to develop and implement programs to ensure the delivery of high quality care and high value services. The QI Coordinator supports the optimization of clinical operations through the identification and implementation of initiatives focused on improving operational and program efficiencies and effectiveness. The QI Coordinator performs QI activities in accordance with Continuous Quality Improvement (CQI) principles and the Plan, Do, Study, Act (PDSA) methodology.
- Analyze, develop, implement and monitor clinical quality improvement initiatives to achieve quality outcomes including activities related to the coordination of the Healthcare Effectiveness Data and Information Set (HEDIS®) Audit; such as selection of HEDIS intervention measures, annual work plan development, roadmap preparation, data collection, medical record audits, analysis, reporting and corrective action plan development.
- Participate in the development and support the implementation of member outreach activities to improve performance and member outcomes.
- Maintain and update the HEDIS training manual as needed.
- Assist and/or coordinate projects as directed by the Quality Committee and other interdepartmental teams (e.g., Status reports for Medical Management Committee, Quality Committee and/or Board of Directors as indicated).
- Participate in development of work plan for improvement of star ratings for Affordable Care Act (ACA) Marketplace membership.
- Support medical record data review/collection as it relates to performance improvement goals for risk adjustment and quality management purposes, including contractual obligations.
- Collects, reports, analyzes and trends performance standards for departmental performance reports.
- Perform vendor oversight activities such as but not limited to monitoring compliance with service level agreement and contract requirements, and contract development and maintenance.
- Assist in the development, communication and implementation of Quality Management Committee decisions and/or corrective action plans.
- Work in collaboration with key stakeholders to target opportunities for improved quality, risk adjustment, clinical and documentation workflow, member experience and performance.
- Maintain collaborative team relationships with peers, colleagues, and physician practices in order to effectively and efficiently achieve goals and foster a positive work environment.
- Support process improvement to enhance workflow and drive performance improvement.
- Perform duties and functions to comply with quality program requirements and State, Federal, FEP, 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 Work Experience
- 3 years quality improvement and health management experience in a healthcare or managed care setting
- Bachelor’s degree in healthcare administration, public health, nursing, social work or health related field
Licensed Registered Nurse, Licensed Practical Nurse or Licensed Clinical Social Worker
Utilization Management and/or Case Management Certification
Certified Professional in Healthcare Quality (CPHQ) or other quality-related certification
Required Job Skills
- Advanced Proficiency with Microsoft office suite applications, records retrieval systems/applications; HEDIS certified vendor databases, National Committee for Quality Assurance (NCQA) Interactive Data Submission System(IDDS) tool
- Knowledge of NCQA HEDIS® regulations including roadmap development and submission and accreditation standards.
- Knowledge of HEDIS® project lifecycle, milestone dates and submission deadlines
- Knowledge of URAC and NCQA standards
Required Professional Competencies
- Excellent written and verbal skills including ability to compose a variety of business correspondence
- Ability to process and evaluate complex data and information sets
- HEDIS® Project Management
- Health care payor business knowledge including supporting processes, operational data and functions
- Maintain confidentiality and privacy
- Analytical knowledge to research and make decisions based on available information to complete activities
- Practice interpersonal and active listening skills to achieve customer satisfaction and departmental communication standards
- Knowledge of managed care delivery models across the continuum of care
- Establish and maintain working relationships in a collaborative team environment
- Organizational skills with the ability to prioritize tasks and work with multiple priorities
- Independent and sound judgment with good problem solving skills
Required Leadership Experience and Competencies
- Ability to use available information to focus project’s scope and identify priorities
- Represent BCBSAZ in the community
- Demonstrate effective presentation skills
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.