Medical Services Program Review Specialist

The Division of Health Care Management (DHCM) is looking for a highly motivated individual to join our team as a Medical Services Program Review Specialist. This position reports to the Quality Management Supervisor within the Division of Health Care Management. This position is responsible for administrative functions related to processing, auditing, tracking, and trending of contractor and provider reported Incident, Accident and Death Reports (IAD), Seclusion and Restraint (SAR) reports and Quality of Care concerns (QOCs). As a Quality Management Analyst, the chosen candidate will provide support to the QM Supervisor and the QM Manager including the development and continuous improvement of the contractors reporting and investigation process, internal contractor compliance audit process, documentation of QM portal reports as appropriate, documentation of unit processes, weekly summary reports on contractor compliance with timeliness standards, and detailed records of all audit findings. This position will also support documentation, tracking, and trending of systemic QOCs.

* Administrative functions related to processing, auditing, tracking, and trending of contractor and provider reported Incident, Accident and Death Reports (IAD), Seclusion and Restraint (SAR) reports and Quality of Care concerns (QOCs).

* Development and continuous improvement of the contractors reporting and investigation process audits, documentation of QM portal reports as appropriate, documentation of unit processes, weekly summary reports on contractor compliance with timeliness standards, and detailed records of all audit findings.

* Tracking of systemic QOCs and trending of case timelines, volumes, etc.

* Coordination of QM related group email boxes to ensure incoming communication is documented and routed to the appropriate unit and/or person.

* Participation in unit and Division meetings, including but not limited to Huddle Board, QM Staffing, Case Resolution, Medical Director Review, Health and Safety, Clinical Staff, and DHCM Quarterly meetings.

* Quality management principles

* Principles and practices of physical and behavioral health services, medical terminology, and community health resources

* Statistical analysis and graphical representation of data

* Microsoft Office (or comparable software program), Share Point, database manipulation, etc.

* Communications both oral and written, including a demonstrated ability to present information to large groups of medical professionals.

* Ability to cross reference case investigation with contractor policy to ensure adherence

* Ability to interpret data on a large scale and created trending reports for the QM unit

* One-two years working in a managed care environment, preferably within quality and/or Arizona

* Three to four years experience working with physical and behavioral health service delivery systems

* One to two years experience with quality related requirements and auditing processes

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.