Manager, Performance/Quality Improvements - HYBRID

PURPOSE OF THE JOB

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.

QUALIFICATIONS

• Required Work Experience: 5 years experience in the health care payer or provider space
• Required Education: Bachelor’s Degree
• Required Licenses: N/A
• Required 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
• Preferred Qualifications: 10 years healthcare experience, within the Arizona Medicaid system preferred; Experience leading system-wide interdisciplinary improvement projects; Master’s degree in business, healthcare administration or healthcare related field; Master’s degree preferred
• Preferred Licenses: N/A
• Preferred Certifications: N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• 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
• Develops and monitors 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
• Maintains confidentiality, privacy and security of protected information
• Maintains a full-time work schedule of 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 Job Skills: 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 accomplishment working with executives across a multi layered organizational platform; Proficiency in developing and presenting analytic reports including written and verbal communication, data collection, sampling, analysis and presentation; Excellent analytical and problem solving skills; Ability to establish trust with all levels of stakeholder groups; Exceptional interpersonal, influence, collaboration and listening skills; Strong written communication skills including ability to use Microsoft applications such as MS Project, Word, Excel and PowerPoint; Advanced PC proficiency with word processing, spreadsheets and presentation software; Ability to maintain confidentiality, privacy and security of protected information
• Required Professional Competencies: Strategic and consultative approach to program management; Strong analytical skills with ability to quickly identify issues, root causes and solutions; Ability to make decisions confidently and work independently; Flexible and willing to adjust to changing priorities
• Required Leadership Experience and Competencies: Confidence working with all levels of the organization and external partners; Collaborative and motivational leadership style across multiple teams; Ability to handle sensitive and confidential situations with professionalism and diplomacy
• Preferred Job Skills: Advanced PC proficiency with word processing, spreadsheets and presentation software; Experience with Daptiv preferred
• Preferred Professional Competencies: N/A
• Preferred Leadership Experience And Competencies: N/A

OUR COMMITMENT

Blue Cross Blue Shield of Arizona 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.