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Job Information
Job Title:  QUALITY MANAGEMENT MANAGER 
Agency:  ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM - AHCC 
Job Reference ID:  59696 
Category:  HEALTHCARE SUPPORT 
Grade:  24 
Posted Date:  11/06/2020 
Close Date:   
Job Description



 

Arizona Health Care Cost Containment System

Accountability, Community, Innovation, Leadership, Passion, Quality, Respect, Teamwork

 

 

Quality Management Manager

 

 

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!

 

JOB SUMMARY:

The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Quality Management Manager . After extensive training, this position has the potential of being worked from home with some in office meetings. 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, SMI Integrated, GMH/SU and CRS systems. Additionally, this position also works closely with the Division of Fee for Service Management and their QM program for FFS members. The position is responsible for monitoring compliance with State and Federal regulations pertaining to QM monitoring systems, tracking and trending quality of care complaints, conducting on-site operational reviews, focused reviews, and evaluating effectiveness of actions taken to improve care. This position will be responsible for coordinating and communicating with Contractors during immediate jeopardy situations to ensure the health and safety of AHCCCS members as well as running the AHCCCS Health and Safety Committee . 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. Provide leadership and fulfill monitoring and oversight responsibilities related to the integrated programs, particularly the Children's Rehabilitation Services (CSR) and the Seriously Mentally Ill (SMI) programs. 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 .

 

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):

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.

 

SELECTIVE PREFERENCE(S):

Certified Professional in Healthcare Quality or behavioral health-related certificate

 

3-5 years of experience in Case Management and/or behavioral health. One-two years of supervisory experience.

 

3-5 years of experience working in a managed care environment.

 

 

 

BENEFITS   

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.

Click the APPLY NOW button to submit your application.

For technical assistance, email [email protected] or call 602-542-4700.                                                                                                              

 
Position Requirements
Position Level:    Hours:   
 Work Arrangement:     Employment Type:   
Hourly Rate:  $0.00 / per hour  Salary:  $70,000.00-87,500.00 

 

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