Quality Management Manager

Salary: $70,000 - $87,500

Grade: 24

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.

* 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.

* 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.

* 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.

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.