The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as an Quality Management Manager . With supportive leadership from the Deputy Director of Clinical Operations, this position will provide oversight of quality management (QM) systems within the statewide AHCCCS managed care programs. This includes monitoring and oversight of AHCCCS Contractors including ALTCS, Acute, DDD, Tribal, SMI Integrated, GMH/SU and CRS systems.
• Managed 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. Provide leadership and fulfill monitoring and oversight responsibilities related to the integrated programs, particularly the Children's Rehabilitation Services (CRS) and the Seriously Mentally Ill (SMI) programs.
• Manage the receipt, research, documentation, and resolution of quality-of-care issues utilizing standardized processes and centralized database. 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 provide technical assistance to Contractors and FFS providers, as appropriate, regarding contractual and/or policy requirements, accurately and consistently to improve compliance with AHCCCS requirements and improve quality of care and service 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.
• Participate in the development of improved processes and procedures to improve efficiency of the QM Unit. Coordinate appropriate referrals to clinical regulators, ADHS, Attorney General, etc. Monitor survey results from ADHS Licensure and ensure communication of actionable items.
• Coordinate and complete tracking, evaluation, and responses to Contractor deliverables. Research, monitor and evaluate standards of practice and practice guidelines for implementation by AHCCCS Contractors to assure all program components are thoroughly and appropriately addressed.
• Participate in special projects and reviews and assure that assigned projects are completed within the designated timelines, with ongoing updates to CQM Manager and Division management. Lead and/or participate in individual and ongoing meetings, including agendas, attainment of speakers, minutes and resulting, Supervision of eleven (11) QM medical professionals, preparing MAPS, planners, etc Participate in peer review processes and initiate resulting activities as directed by the AHCCCS Chief Medical Officer. Participate in Case Resolution meetings and staff cases 1:1 as requested.
• Medical/nursing practice, medical case management protocols, utilization review protocols as related to the acute, LTC, chronic long-term elderly and physically disabled, developmentally disabled, behavioral/mental health and tribal.
• State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, LTC and Tribal.
• Current nationally accepted quality management standards and criteria Healthcare delivery systems, nationally and locally including integrated care and coordination of care theories.
• Acute nursing and/or behavioral health processes including assessment, planning, intervention, and evaluation.
• Strong interpersonal skills in order to effectively relate to AHCCCS members and their families; multi-disciplinary professions and Contractor representatives.
• Effectively lead a team through complex workloads and challenging scenarios.
• Assess members from a holistic perspective with an emphasis on recognizing medical, social, environmental, and emotional conditions, barriers for meeting medical needs that interfere with the member's ability to function within his/her limitations.
• Certified Professional in Healthcare Quality or behavioral health-related certificate
• 3-5 years’ experience working in a managed care environment
• 3-5 years’ experience in Case Management and/or behavioral health. One-two years of supervisory 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.
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.
ARIZONA MANAGEMENT SYSTEM (AMS)
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.
The State of Arizona is an Equal Employment Opportunity Employer.