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Managed Care Program Administrator

4 months ago

Phoenix, United States Arizona Official Website of State of Arizona Full time

Job Summary:

Would you like to be part of an amazing team that makes Arizonans thrive? At the Department of Economic Security (DES) we strengthen individuals, families, and communities for a better quality of life. DES is looking for individuals who are committed to service, community, and teamwork. To learn more about DES please visit or click on the link to view ‘Our DES’ video. Come join the DES Team

The Department of Economic Security, Division of Developmental Disabilities (DDD), is seeking an experienced and highly motivated individual to join our team as a Managed Care Program Administrator - QI/PI Manager. This position is responsible for ensuring that the DOD participates in active and continuous performance improvement initiatives; contractually mandated Performance Measures (including the National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information System (HEDIS) and the Center for Medicaid and Medicare Services (CMS) Core Measures), Performance Improvement Projects, and other activities of quality and performance improvement; data analysis to identify opportunities for improvement, demographic/health disparities, and assessment of effectiveness and sustained improvement.

Applicants for this position cannot be licensed or certified by the DDD Office of Licensing Certification and Regulation, cannot have a principal interest in or have a spouse or close family with principal interest in a DDD Qualified Vendor Agreement, and cannot be employed or subcontracted by a DDD Qualified Vendor.

This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures.

The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust. Across our many agencies, boards, and commissions, many State employees participate in the State’s Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces. All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.

Job Duties:

Essential Duties and Responsibilities include but not limited to:

Leads team in direct management of DDD specific performance evaluates sub-contractor performance. Responsible for implementation and oversight of initiatives that will directly impact achievement and/or sustainment of Minimum Performance Standards (MPS) outlined in Contract. Leads hybrid reviews and ensures sufficient quality checks of all submitted medical records and other supporting documentation. Leads team to develop and select Performance Improvement Project (PIP) topics to evaluate clinical and non-clinical care related to specific or all populations. Develop and implement methodologies, develop data requests, review programming, perform quality checks on data samples, collect and analyze results, research best practices, interventions and activities to improve outcomes, and write and publish outcome reports. Leads team in coordinating quality improvement initiatives. Lead analysis of data, facilitate identification of interventions, develop implementation plan, monitor implementation and report outcomes of quality improvement activities. Respond to data requests related to performance improvement projects. Providing supervision, mentoring, and coaching of staff to ensure compliance with regulations and policies of the ODD. Facilitating regular 1: 1 s, team huddles, and other communication modalities with the QI team. Completing Performance Appraisals, authorizing leave, and approving ETE Time Cards for staff. Receives data, develops and runs system queries, conducts data analysis, and utilizes results to recommend quality improvement opportunities; identifies gaps, barriers and activities that are effective in improving care and services to members. Assess for disparities and develop interventions for improvement. Identifies deficiencies and recommends corrective action. Knowledge, Skills & Abilities (KSAs):

Knowledge:

Comprehensive knowledge of quality and process improvement principles and practices and methodologies, including the Plan-Do-Study-Act (PDSA) cycle. Comprehensive knowledge of DDD Policy and Procedures, Administrative Directives, and the service delivery system. DDD Mission and Value statements, local, state, and federal laws, and other related governing documentation surrounding DDD practices. Human dynamics and organizational systems. Applicable laws, rules, policies, procedures and contracts for Arizona Health Care Cost Containment System (AHCCCS).

Skills:

Effective oral and written communication skills. Analyze problems and develop effective plans for corrective action. Continuous improvement and financial accountability. Word processing, spreadsheet and database applications. Management and leadership techniques.

Abilities:

Evaluate data and documents relate with multi-level of employees and organizational personnel. Plan and organize complex work and complete reports based on data, and document in a clear and professional manner. Lead and direct assigned employees. Clear and concise communication; work cooperatively with others, establish and maintain relationships. Selective Preference(s): The ideal candidate for this position will have: Minimum of two (2) years of experience working with Intellectual Disability population, At least two (2) years of work experience in a performance improvement role, At least two (2) years of work experience with HEDIS and CMS Core measures. Pre-Employment Requirements: Certified Professional in Healthcare Quality (CPHQ) by the National Association for Health Care Quality (NAHQ) or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers, or comparable education and experience in health plan data and outcomes measurement. Candidates for this position shall be subject to a search of the Child Protective Services Central Registry pursuant to A.R.S. 8-804. In accordance with the Arizona Health Care Cost Containment System contract as defined in 42 CFR 455,104, SMDL #09-001, a search for the incumbent will be conducted monthly using the List of Excluded Individuals and Entities (LEIE) and the System for Award Management (SAM). If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Any employee operating a motor vehicle on State business must possess and retain a current, valid class-appropriate driver’s license, complete all required training, and successfully pass all necessary driver’s license record checks. The license must be current, unexpired, and neither revoked nor suspended. Employees who drive on state business are subject to driver’s license record checks, must maintain acceptable driving records, and must complete all required driver training. An employee who operates a personally owned vehicle on state business shall maintain the statutorily required liability insurance (see Arizona Administrative Code (A.A.C.) ). All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify). Successfully pass background and reference checks; employment is contingent upon completion of the above-mentioned process and the agency's ability to reasonably accommodate any restrictions. Benefits:

The Arizona Department of Economic Security offers a comprehensive benefits package to include:

• Affordable medical, dental, life, and short-term disability insurance plans
• Participation in the Arizona State Retirement System (ASRS) and long-term disability plans
• 10 paid holidays per year
• Vacation time accrued at 4.00 hours bi-weekly for the first 3 years
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
• Sick time accrued at 3.70 hours bi-weekly
• Deferred compensation plan
• Wellness plans
• Tuition Reimbursement
• Stipend Opportunities
• Infant at Work Program
• Rideshare and Public Transit Subsidy
• Career Advancement & Employee Development Opportunities
• Flexible schedules to create a work/life balance

By providing the option of a full-time or part-time remote work schedule, employees enjoy improved work/life balance, report higher job satisfaction, and are more productive. Remote work is a management option and not an employee entitlement or right. An agency may terminate a remote work agreement at its discretion.

Learn more about the Paid Parental Leave pilot program . For a complete list of benefits provided by The State of Arizona, please visit our

Retirement:

State employees are required to participate in the Arizona State Retirement System (ASRS), the State-sponsored retirement contribution plan and the Long-Term Disability (LTD) program after a 27-week waiting period. The ASRS-defined benefit plan provides for life-long income upon retirement. You will also have the option to participate in a voluntary deferred compensation program to take advantage of tax-deferred retirement investments.

On, or shortly after, your first day of work you will be provided with additional information about the available insurance plans, enrollment instructions, submission deadlines and effective dates.