Overview Manager, Health Plan Records (Hybrid) at Blue Cross Blue Shield of Arizona. This hybrid/Workability role requires residency in Arizona with on-site expectations as described in the posting.
AZ Blue offers a hybrid workforce strategy with onsite, hybrid, or remote classifications. Onsite requirements may change based on business needs. Most employees should expect onsite requirements at a minimum once per week.
This position is hybrid within the state of AZ only and requires 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, with strong leadership and project-management skills. Advanced proficiency with Excel and Microsoft applications is essential.
Qualifications Required Qualifications 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
Required Licenses Active license in any U.S. state or territory: LPN or RN
Required Certifications None
Preferred Qualifications 4 years of experience in a clinical and/or health plan environment
Bachelor\'s degree in business, public health, nursing, or related area
Active or inactive license in any U.S. state or territory as LVN/LPN/RN or similar
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 best practices to ensure successful HEDIS season and continuous quality improvement.
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 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 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 (40+ hours/week, plus additional hours as needed).
Performs all other duties as assigned.
Competencies Required Competencies Independently manages projects, timelines, coordination, troubleshooting, and reporting.
Advanced proficiency with software applications used in HEDIS activities; proficient in Microsoft Teams, Outlook, Excel, EMRs, registries, and HIEs.
Subject matter expertise in legal health records, EMR/HIE search techniques, and clinical registries.
Strong time and productivity management; ability to adapt to shifting priorities.
Excellent organizational skills and attention to quality; knowledge of NCQA HEDIS Compliance Audit deliverables.
Professional & Leadership Competencies Independently manages assignments, time, and priorities; collaborates with leadership and peers; maintains confidentiality and privacy per regulations.
Leads stakeholder engagement and can communicate with regulators, auditors, providers, and internal teams.
Ability to manage multiple tasks in a fast-paced environment with minimal supervision.
About 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, see azblue.com. If interested in this position, please apply.
Location: Scottsdale, AZ