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.
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.
PURPOSE OF THE JOB
The Senior Manager of Quality Informatics oversees the integration of data analytics and healthcare technology to improve clinical quality and care outcomes. This role also manages the annual Healthcare Effectiveness Data and Information Set (HEDIS) and Arizona Health Care Cost Containment System (AHCCCS) Medicaid submissions.
QUALIFICATIONS
Required Work Experience
Five or more years of progressive experience in healthcare data analytics, clinical informatics, or quality improvement.
Three or more years in a dedicated managerial or director-level role supervising clinical analysts, data scientists, or informatics teams.
Three or more years of experience with health data tools such as SQL, Tableau, Power BI, or dedicated HEDIS engines, including Cotiviti, Inovalon, or Optum.
Direct experience leading annual HEDIS submission cycles, including managing vendor relationships, medical record retrieval, and NCQA audits.
Experience managing diverse data streams, including medical claims, pharmacy data and PBM feeds, laboratory results, and Electronic Clinical Data Systems (ECDS).
Required Education
Bachelor's degree in Healthcare Administration, Health Information Management, Medical Informatics, or Computer Science.
Preferred Work Experience
Documented success improving CMS Star Ratings, Medicaid managed care quality metrics, or state-mandated pay-for-performance programs.
Demonstrated ability to work with executive leadership and provider networks to implement clinical workflow changes that successfully close gaps in care.
Preferred Education
Master of Science in Health Informatics (MSHI).
Master of Health Administration (MHA).
Master of Business Administration (MBA) with a concentration in healthcare analytics or quality management.
Master of Public Health (MPH).
Preferred Licenses
None.
Preferred Certifications
Lean Six Sigma Green Belt or Black Belt.
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
Manage a team of data analysts, SQL developers, and informatics specialists.
Lead the end-to-end annual HEDIS submission roadmap, ensuring all data mapping, medical record review, and hybrid data collection activities comply with NCQA specifications.
Synthesize and forecast quality…