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.
Essential Job Functions and Responsibilities
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 of 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 the development of a work plan for improvement of star ratings for the 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 a 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 of consecutive quality improvement and health management experience in a healthcare or managed care setting
Required Education
Bachelor’s degree in healthcare administration, public health, nursing, social work or health-related field
Preferred Education
Master’s Degree in health care administration, public health, business or related field of study
Preferred Certifications
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 the 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 on the project’s scope and identify priorities
Represent BCBSAZ in the community
Demonstrate effective presentation skills
Preferred Professional Competencies
Knowledge and experience working with Microsoft project
Knowledge of CPT-4, HCPCS, Hierarchical Condition Category (HCC), ICD-10 coding and Risk Adjustment
Knowledge of a variety of software applications to manage HEDIS® or Quality Improvement Project
If you are interested please click the link below to apply:
Comply with BCBSAZ corporate and departmental policies and procedures, including, but not limited to Code Blue, Compliance, HIPAA, Computer Responsibility, Accreditation Standards, Attendance, Staff Qualifications and Quality Management Accountabilities.
Our Commitment
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 1,800 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.
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.
Internal Number: 5514
About Blue Cross Blue Shield of Arizona
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 1,800 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.
BCBSAZ does not discriminate in h
