Quality Improvement Specialist FEP-MA (Hybrid / Remote)

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.

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.

Job Description

The Quality Improvement Specialist (QIS) supports operations and activities to ensure the overall QI Program objectives and goals are achieved. This includes responsibility for collecting and analyzing data and information needed to support the development, implementation, and evaluation of programs, which may require learning various platforms and digital tools. This role will also drive provider quality and risk adjustment performance by monitoring, strategizing, and meeting with provider groups and internal support teams to collaborate on driving provider performance to improve overall contract performance for the plan.

REQUIRED QUALIFICATIONS

Required Work Experience

• Minimum 2 years healthcare quality, risk adjustment, or performance improvement and/or health/disease/population management with at least 1 year of experience in a physician practice, or managed care/healthplan;
• Minimum 1 year collecting and analyzing quality-related data sets to support quality reporting.

Required Education

• High School Diploma or GED in general field of study

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 3+ years healthcare quality, risk adjustment, or performance improvement, and/or health/disease/population management with at least 2 years experience in a healthcare, physician practice, or managed care;
• 2+ years collecting, analyzing, and reporting on quality-related data sets.

Preferred Education

• Bachelors degree in healthcare administration, public health, social work or health related field.

Preferred Licenses

• N/A

Level 1

* Assess, collect, and 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), risk adjustment recapture, and Consumer Assessment of Healthcare Providers and Systems (CAHPS).

* 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 quality improvement teams 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 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, collegues, 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.

* 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

• This position requires Arizona residency and the ability to travel to provider offices when required.

Level 2

* Lead quality improvement data activities by assessing, collecting, analyzing various, complex data sources including data related to the measurement and improvement of the Healthcare Effectiveness Data and Information Set (HEDIS), risk adjustment recapture, and Consumer Assessment of Healthcare Providers and Systems (CAHPS).

* Lead the development and execution of activities supporting the Quality Program Descriptions, Workplans, and evaluations, policies and procedures, including corporate and QI team expectations.

* Manage partnerships with provider groups at high risk for low performance.

* Partner with quality improvement teams to lead 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.

* Advise leadership and program partners on opportunities to improve the quality improvement program and then execute.

* Create reporting models for evaluating program outcomes and propose opportunities to render higher Return on Investment (ROI).

* Demonstrates and actively engages in developing a strong understanding amongst partners and quality improvement partners of quality improvement concepts, such as, but not limited to, HEDIS, HOS, CAHPS, risk adjustment, chronic condition management, utilization, and quality analytics.

REQUIRED COMPETENCIES

Required Job Skills

• Ability to quickly learn and understand CMS regulatory and contractual documents, including corporate policies & procedures; Knowledge of Medicare Advantage Stars, Risk Adjustment, the Federal Employee Program, and/or NCQA accreditation standards, including HEDIS.
• Previous experience working in strategy development and implementation, analytical and Quality-based process improvement in the health care health insurance sector or management analytics.
• Ability to interpret data in various forms, primarily in Excel and dashboards
• Technical Skills
• Microsoft Suite, Microsoft Excel (Intermediate), Microsoft PowerPoint (Intermediate)
• Excellent writing skills with the ability to compose and deliver a variety of business correspondence
• Excellent verbal skills including ability to present to various audiences

Required Professional Competencies

• Ability to hold providers accountable for program performance
• Demonstrated analytical and critical thinking skills
• Demonstrated interpersonal/verbal communication skills
• Demonstrated written communication skills
• Ability to work in a matrixed environment
• Ability to work as part of a team
• Ability to manage a project-based portfolio with constant deliverables
• Ability to interpret data trends and extrapolate insights for improvement
• Adept at partnership and collaboration both internally and externally

PREFERRED COMPETENCIES

Preferred 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

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.