Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
Quality Management Coordinator
This position will remain open until filled.
Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Medicaid Agency, is driven by the passion to deliver comprehensive and cost effective health care to Arizonans in need. AHCCCS is nationally acclaimed as a model for other Medicaid programs and recipient of multiple awards for excellence in workplace effectiveness and flexibility. Visit our careers page to learn more about AHCCCS. Use your skills to benefit others; join the AHCCCS Team!
The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Quality Management (QM) Coordinator. Under the leadership of the QM Manager and Clinical Administrator, this position participates in the oversight of QM systems within the statewide managed care organizations (MCOs) and AHCCCS fee-for service programs. The position is responsible for understanding the needs of stakeholders especially those of members with unmet health care needs, members diagnosed with a Serious Mental Illness (SMI) or other behavioral health conditions, members diagnosed with developmental delays, members with special health care needs, and families of children with special health care needs. This position will work directly with ALTCS, Acute, foster care (CMDP), CRS, DDD, AIHP, and RBHA quality management areas; however, the primary focus will be on cases involving behavioral health conditions. Major duties and responsibilities include but are not limited to:
* Receive, research, document, and resolve quality of care issues 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 issues 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 issue. Use appropriate judgment regarding data to research, regulatory referrals, status level, interventions, and appropriate resolution.
* Participate in special projects and reviews as assigned and assure completion within the designated timelines; participate in peer review processes including presentation of challenging and high profile cases, and initiate resolution activities as directed by the AHCCCS Chief Medical Officer. Provide ongoing updates to leadership.
* Current, active Arizona RN license; working knowledge of medical/nursing practice, medical case management protocols, utilization review protocols as related to assigned populations (e.g. Acute, Behavioral Health, Long Term Care).
* Demonstrated knowledge of the behavioral health delivery system.
* Ability to evaluate unique member needs and assure quality system provisions.
* Strong interpersonal skills in order to effectively relate to AHCCCS members, their families, and Agency stakeholders.
* Project management methodologies; producing work products with limited supervision; ability to multi-task in a fast-paced environment.
* In-depth knowledge of problem solving and technical writing.
* Demonstrated skills using Microsoft Office (such as Word, Excel and Outlook) as well as use of multiple data systems.
* Certified Professional in Healthcare Quality
* One-two years experience working in a managed care environment
* Case Management and/or social work experience
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. Click here to learn more about benefits.
Arizona State Government is an EOE/ADA Reasonable Accommodation Employer.
All newly hired employees will be subject to E-Verify Employment Eligibility Verification.
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For technical assistance, email [email protected] or call 602-542-4700.