PURPOSE OF THE JOBThe 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.
QUALIFICATIONSRequired 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 LicensesNone.
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 performance data to target and meet minimum performance standards.
- Present technical quality metrics and performance information to executive leadership, along with actionable, data-driven program recommendations.
- Collaborate with key stakeholders to develop analyses that support strategic goals.
- Collaborate with internal teams, including IT, and external providers and partners to develop additional data sources that support quality measurement activities.
- Provide training and orientation, conduct performance appraisals, and oversee hiring and disciplinary actions for informatics staff.
- 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.
COMPETENCIESRequired Job Skills- Strong knowledge of relational databases and healthcare data models, with the ability to guide teams in using SQL to extract and manage population health datasets.
- Understanding of healthcare data exchange protocols, specifically HL7 and FHIR standards, and Electronic Clinical Data Systems frameworks.
- Ability to build and interpret executive dashboards using business intelligence tools such as Tableau or Power BI.
Required Professional Competencies- Comprehensive understanding of NCQA HEDIS and CMS Core Set technical specifications.
- Expertise in the mechanics of CMS Star Ratings.
Required Leadership Experience and CompetenciesNone specified.
Preferred Job Skills- Proficiency in predictive modeling tools and techniques used to forecast year-end performance and identify impactable, rising-risk member populations.
- Experience using Natural Language Processing tools to scan unstructured clinical text and support supplemental data activities.
- Understanding of how quality informatics relates to alternative payment models.
Preferred Professional Competencies- Knowledge of digital quality measures.
- Ability to transition manual HEDIS processes to automated Electronic Clinical Data Systems extraction.
Preferred Leadership Experience and CompetenciesNone specified.
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.
