Arizona Health Care Cost Containment System
Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork
Quality Management Manager
First Resume Review: 03/06/2020
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.
All Arizona state employees operate within the Arizona Management System (AMS), an intentional, results-driven approach for doing the work of state government whereby every employee reflects on performance, reduces waste, and commits to continuous improvement with sustainable progress. Through AMS, every state employee seeks to understand customer needs, identify problems, improve processes, and measure results. State employees are highly engaged, collaborative and embrace a culture of public service. 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 Manager. Under the leadership of the Clinical Administrator, this position will provide oversight of quality management systems within the statewide managed care AHCCCS programs. This includes monitoring and oversight of AHCCCS Contractors including ALTCS Elderly/Physically Disabled and DDD, ACC, SMI and foster care systems. Major duties and responsibilities include but are not limited to:
* Manage oversight responsibilities of AHCCCS Contractors for all lines of business in the provision of quality health care in compliance with federal, state and AHCCCS quality management requirements.
* Manage the receipt, research, documentation and resolution of quality of care issues utilizing standardized processes and centralized databases. Track, trend and monitor status of cases to ensure accurate and timely completion and appropriate referrals. Ensure research and resolution of quality of care issues in a timely manner as assigned and identify systemic issues for AHCCCS to address. Monitor the productivity and timeliness of the QM staff conducting the quality of care resolution processes. Develop interventions to improve outcomes. Provide data and information for federal and state reporting.
* Provide technical assistance to Contractors as appropriate, regarding contractual and/or policy requirements, accurately and consistently to improve compliance with AHCCCS requirements and improve quality of care and services to AHCCCS members. Ensure the efficacy and effectiveness of health care delivery systems.
* Lead the QM team in participation in operational reviews, technical assistance and focused studies/reviews to ensure compliance with contractual and policy requirements for all lines of business. Monitor 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 dignity and respect, timely correspondence with member acknowledging receipt and upon resolution of the issue. Use appropriate judgment regarding data to research, status level, interventions and appropriate resolution.
* Provide leadership and fulfill monitoring and oversight responsibilities related to the integrated programs and services. Participate and/or lead teams in the development, implementation and evaluation of AHCCCS Medical policies, administrative policies, technical assistance tools, performance measures, performance improvement projects, audits and studies for the AHCCCS program.
KNOWLEDGE, SKILLS AND ABILITIES (KSAs):
* Current, active AZ RN license. In good standing with AZ Nursing Board.
* Demonstrated experience in physical and behavioral health care practices, quality management protocols, and clinical review protocols as related to ACC, Seriously Mentally Ill, chronic long-term elderly and physically disabled, intellectually/developmentally disabled, behavioral health/substance use and Tribal populations.
* Strong interpersonal skills in order to effectively interact with AHCCCS members and their families; multi-disciplinary professions and Contractor representatives.
* Excellent communication with all levels, both verbally and written; skilled in problem-solving and technical writing.
* Demonstrated managed care expertise, particularly in the areas of quality management and utilization/medical management.
* Two-three years’ experience working in a managed care environment.
* Two-three years of supervisory experience.
* Certified Professional in Healthcare Quality
* Strong knowledge of investigative techniques with strict adherence to privacy and discretion.
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. Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 417-4497. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. AHCCCS is an Equal Employment Opportunity Employer. All newly hired employees will be subject to E-Verify Employment Eligibility Verification.
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For technical assistance, email HRIShelpdesk@azdoa.gov or call 602-542-4700.