Manager, Performance​/Quality Improvements - HYBRID

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.

AZ Blue offersa 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.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week
• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week
• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month
• Onsite: daily onsite requirement based on the essential functions of the job
• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is hybrid within the state of AZ only.

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

The position is responsible for managing Quality Improvement activities as well as staff conducting quality improvement work as outlined in AHCCCS contract and policy for the Medicaid Segment. This position and staff reporting to this position shall reside in Arizona within the Geographical Service Area for contract compliance, have knowledge of both physical and behavioral health service delivery, monitor, review and evaluate performance measure data and technical specifications.

The employee holding this position shall not hold any other position within the organization.

• Work Experience:
  
  5 years experience in the health care payer or provider space
• Education:
  
  Bachelor’s Degree
• Licenses: N/A
• Certifications:
  
  CPHQ through the National Association for Health Care Quality (NAHQ) or is a CHCQM through the American Board of Quality Assurance and Utilization Review Physicians

• Work Experience:
  
  10 years healthcare experience, within the Arizona Medicaid system preferred
• Experience leading system-wide interdisciplinary improvement projects
• Education:
  
  Master’s degree in business, healthcare administration or healthcare related field
• Licenses: N/A
• Certifications:
  
  N/A

• Responsible for driving performance improvement for National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) and other quality metrics
• Develops and implements system-wide performance improvement projects
• Development and monitoring of Corrective Action Plans for effectiveness in achieving performance targets and reporting on effectiveness of recommended actions
• Collaborates with internal departments including Quality Management, Performance Improvement and Quality Analytics on NCQA HEDIS performance measurement to ensure data integrity
• Supervises employees performing performance improvement and monitoring functions
• Reports quality improvement and 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 multiple sources to identify and respond to trends and or emerging issues and to ensure compliance with minimum standards
• Utilizes data to develop intervention strategies to improve outcomes and reports quality improvement and performance outcomes as requested to ensure ongoing compliance with contractual requirements
• Conducts research, reviews, analyzes and compiles data, develops recommendations and reports
• Some travel is required to attend meetings with AHCCCS, provider agencies and other meetings as assigned
• The position has an onsite expectation of 2 days per week and 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.
• Perform all other duties as assigned

• Subject matter expertise with NCQA HEDIS and CMS Core performance measure calculation and data collection methodologies
• Experience with Medicaid managed care organizations
• Proven record of…