The Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid agency, is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need. AHCCCS is a nationally acclaimed model among Medicaid programs, and a recipient of multiple awards for excellence in workplace effectiveness and flexibility. Among government agencies, AHCCCS is recognized for high employee engagement and satisfaction, supportive leadership, and flexible work environments, including remote work opportunities. With career paths for seasoned professionals in a variety of fields, entry-level positions, and internship opportunities, AHCCCS offers meaningful career opportunities in a competitive industry. AHCCCS employees are passionate about their work, committed to high performance, and dedicated to serving the citizens of Arizona.
Salary: $55,000.00 to $64,000.00
The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a QM Coordinator. This position is responsible for the oversight and review of the quality of care concern investigation process involving behavioral health services and providers. This position is responsible for communication and collaboration with contracted health plans, participating in the development, implementation, and monitoring of the quality care management functions within the DHCM Clinical Quality Management Unit, other divisions within AHCCCS, and other State agencies. After initial training and orientation this position will be primarily virtual with some in-office meetings.
* Receive, research, document, and resolve quality of care concerns utilizing standardized processes and centralized databases. Track, trend, and monitor status of cases to ensure thorough and timely completion as well as appropriate referrals. Primary emphasis will be placed on special populations such as those utilizing behavioral health services. Ensure research and resolution of quality of care concerns in a timely manner as assigned and identify systemic issues for AHCCCS to address.
* Participate in operational reviews, technical assistance, and focused studies/reviews, including the behavioral health delivery system, to ensure compliance with contractual and policy requirements for all lines of business. Follow-up on written reports, corrective action plans, notices to cure and sanctions as appropriate.
* Ensure quality of care to AHCCCS members, including ensuring member health and safety as well as dignity and respect. Focus on unique aspects of each case, individual care needs, timely correspondence with members and timely acknowledgment of concerns as well as resolution of the concern. Use appropriate judgment regarding data to research, regulatory referrals, status level, interventions, and appropriate resolution.
* Provide technical assistance to Contractors and FFS providers, as appropriate, regarding contractual and/or policy requirements to improve quality of care and service delivery to AHCCCS members. Participate in special projects and reviews as assigned and assure completion within designated timelines. Provide ongoing updates to leadership.
* Participate in the development of improved processes and procedures to improve efficiency of the QM unit. Participate in special projects and reviews as assigned and assure completion within designated timelines. Provide ongoing updates to leadership.
* Coordinate and complete tracking, evaluation, and response to contractor deliverables.
* Structure and operation of the Arizona behavioral health system.
* SMI Grievance and administrative appeal process; rules, status and regulations that define the standards of care applicable to the behavioral health system.
* State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, Behavioral Health, LTC and Tribal Children’s Rehabilitative Services.
* Techniques to select a particular approach to analyze develop or implement a policy, project management methodologies and Behavioral Health delivery system.
* Strong interpersonal skills in working with agency management, and people of diverse cultures and socioeconomic backgrounds, project management to meet goals and deadlines.
* Communicate orally and in writing with members, contractors, and providers to facilitate resolution or presenting issues.
* Read, interpret, and apply complex rules and regulations.
* Certified Professional Healthcare Quality
* At least two-year professional healthcare industry experience in Quality or Utilization Management or five years of experience in the behavioral health field, preferably in the context of the delivery of service in Arizona’s public behavioral health system.
At AHCCCS, we promote the importance of work/life balance by offering workplace flexibility and a variety of learning and career development opportunities. Among the many benefits of a career with the State of Arizona, there are 10 paid holidays per year, accrual of sick and annual leave, affordable medical benefits and participation in the Arizona State Retirement Plan.
For a complete list of benefits provided by The State of Arizona, please visit our benefits page
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-417-4497.
Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.