Quality Improvement Program Manager - Hybrid

Blue Cross Blue Shield of Arizona•Phoenix, AZ

1d•Hybrid

About The Position

This position supports performance measure monitoring and improvement functions for the Medicaid Segment’s managed care organization. The role oversees performance measures across the organization and provider network for both behavioral and physical health care. Responsibilities include monitoring, reviewing, and evaluating performance measure data and technical specifications. This position must reside in Arizona within the Geographical Service Area to meet contract compliance requirements.

Requirements

5 years of experience in the health care payer or provider space
Bachelor’s Degree
Residency within the State of Arizona
Subject matter expertise in NCQA HEDIS and CMS Core performance measure methodologies
Experience working with Medicaid managed care organizations
Proven ability to collaborate with executive leadership across complex organizations
Strong experience in data analysis, reporting, and presentation (written and verbal)
Excellent analytical and problem-solving skills
Ability to build trust with diverse stakeholders
Strong interpersonal, collaboration, and communication skills
Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, MS Project)
Ability to maintain confidentiality and protect sensitive information
Strategic and consultative program management approach
Strong analytical skills with ability to identify root causes and solutions quickly
Ability to work independently and make confident decisions
Flexibility to adapt to changing priorities
Confidence working with all levels of internal and external stakeholders
Collaborative and motivational leadership style
Ability to manage sensitive and confidential situations professionally

Nice To Haves

10 years of healthcare experience, preferably within the Arizona Medicaid system
Experience leading system-wide interdisciplinary improvement projects
Master’s degree in business, healthcare administration, or related field
Certified Professional in Healthcare Quality (CPHQ) or CHCQM preferred
Advanced proficiency in Microsoft Office and experience with Daptiv preferred

Responsibilities

Drive performance improvement for NCQA HEDIS and other quality metrics
Develop and implement system-wide performance improvement projects
Develop and monitor Corrective Action Plans and evaluate effectiveness
Collaborate with internal departments (Quality Management, Performance Improvement, Quality Analytics) to ensure data integrity
Supervise staff performing performance improvement and monitoring functions
Report performance outcomes to leadership, regulators, and stakeholders
Analyze data and communicate insights and recommendations to internal teams and provider agencies
Monitor and track provider performance to identify trends, issues, and compliance gaps
Develop intervention strategies to improve outcomes and ensure compliance with contractual requirements
Conduct research, analyze data, and produce reports and recommendations
Attend meetings with AHCCCS, provider agencies, and other stakeholders as needed (travel required)
Perform other duties as assigned