HEDIS Manager

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 Health Plan Medical Records Manager leads the strategy, design, implementation, and oversight of medical record review operations to support HEDIS, STARS, and CMS reporting requirements. This role manages a team responsible for medical record retrieval, chart abstraction, audits, overreads, and compliance deliverables. The ideal candidate brings deep knowledge of HEDIS, CMS IDSS submissions, and quality improvement methodologies, reporting along with strong leadership and project management skills. Advanced proficiency with Excel and Microsoft applications is essential for success in this role.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

Required Work Experience

• 3 years/seasons of HEDIS medical record review experience, with at least 2 seasons of over-read responsibilities
• 4 years of experience training or overseeing staff
• 3 years of experience in a clinical, health plan, or health information management environment

Required Education

• High-School Diploma or GED in general field of study

Required Licenses

• Active license in any U.S. state or territory: Licensed Practical Nurse (LPN), Registered Nurse (RN)

Required Certifications

• None

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 4 years of experience in a clinical and/or health plan environment

Preferred Education

• Bachelor's degree in business, public health, nursing, or related area

Preferred Licenses

• Active or inactive license in any U.S. state or territory as a Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Registered Nurse (RN), or similar

Preferred Certifications

• Certified coder or similar credential in health information management
• Certification in healthcare quality or project management (e.g., CPHQ, PMP)

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

Strategic Leadership & Program Oversight

• Lead the strategy, design, piloting, and monitoring of HEDIS Medical Record Review (MRR) projects.
• Develop and implement annual strategies to improve medical record review processes and drive HEDIS performance improvement.
• Oversee the implementation of best practices to ensure a successful HEDIS season and continuous improvement in quality metrics.
• Lead and manage HEDIS compliance audit deliverables, including abstraction overreads, reporting and audit preparation.

Team Management & Development

• Supervise and support the medical records team, including recruitment, onboarding, training, and performance management.
• Ensure team maintains subject matter expertise in HEDIS gap closure, exclusions, new medical technologies, and documentation standards.
• Monitor team accuracy, productivity, and quality, addressing performance issues proactively.

Project & Process Management

• Oversee and manage end-to-end project execution, including timelines, coordination, troubleshooting, and reporting.
• Initiate and manage primary source verification and validation of supplemental data sources.
• Develop and maintain policies, procedures, and training materials; deliver training to internal and external stakeholders.
• Collaborate with cross-functional teams to support continuous measure improvement and data tracking.

Operational Excellence

• Manage all aspects of medical record retrieval, chart abstraction, and audit coordination.
• Ensure timely and accurate CMS IDSS submissions and alignment with regulatory requirements.
• Observe, track, and report on opportunities for improvement and effective practices across projects.
• Serve as a liaison to internal stakeholders (corporate leadership, QI teams) and external entities (accreditation bodies, payers, providers, registries).

OVERALL

• 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
• Performs all other duties as assigned.

COMPETENCIES

REQUIRED COMPETENCIES

Required Job Skills

• Independently manages projects, timelines, coordination, troubleshooting, and reporting.
• Troubleshoots basic desktop/login issues and engages Help Desk when needed.
• Advanced proficiency with software applications and vendor tools used in HEDIS activities.
• Proficient in Microsoft Teams, Outlook, Excel (filter/sort), PDF editing, OneDrive/Windows Explorer, EMRs, registries, and HIEs.
• Subject matter expertise in legal health records, EMR/HIE search techniques, and clinical registries.
• Thrives in a paperless environment.
• Strong time and productivity management, including planning and escalation handling.
• Adapts quickly to shifting priorities and overlapping project timelines.
• Excellent organizational skills and use of checklists to ensure accuracy and quality.
• Working knowledge of NCQA’s HEDIS Compliance Audit deliverables and process.
• Analytical skills for decision-making based on available data.

Required Professional Competencies

• Independently manages assignments, time, and priorities.
• Collaborates transparently with leadership and peers, open to feedback.
• Interprets and applies policies, procedures, and performance measure specifications.
• Intermediate level understanding of HEDIS or similar technical specifications.
• Maintains confidentiality and privacy per regulations.
• Exercises sound judgment and problem-solving skills.
• Manages multiple tasks in a fast-paced environment while keeping stakeholders informed.
• Works with minimal supervision, takes initiative, and leads stakeholder engagement.
• Shares relevant information, offers suggestions, and removes barriers to team success.
• Accountable for long- and short-term multi-faceted projects.

Required Leadership Experience and Competencies

• Effectively engages diverse audiences in high-profile settings, both orally and in writing.
• Communicates professionally with physician leaders, executives, and stakeholders.
• Independently manages complex, multi-stage technical projects.
• Designs and delivers high-quality staff training and refreshers.
• Leads creation and maintenance of written procedures and policies.
• Communicates with discretion and professionalism with regulators, auditors, providers, vendors, and internal stakeholders.

PREFERRED COMPETENCIES

Preferred Job Skills

• N/A

Preferred Professional Competencies

• Outreach and other improvement initiative skills

Preferred Leadership Experience and Competencies

• Successful experience as a team leader or supervisor

Our Commitment

AZ Blue 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.