Healthcare Quality Manager
3 days ago
This nursing position is responsible for leading the Department of Child Safety's (DCS) Comprehensive Health Plan (CHP) clinical and quality contributions as the subject matter expert for the DCS CHP Quality Department. The role promotes quality and cost-effectiveness of healthcare by applying clinical acumen and the appropriate application of State and Federal policies, evidence-based criteria, and guidelines as well as recognized community standards.
Key Responsibilities:- Contributes to individual and systemic quality of care for the DCS CHP Quality Department.
- Performs medical necessity reviews, investigations, and follow-up of quality-of-care concerns, complaints, and grievances.
- Conducts on-site quality management required visits and/or reviews as needed.
- Reports, tracks, and trends, resolves various measures for quality improvement department-wide.
- Reviews, consults, and advises on Root Cause Analysis (RCA) and Failure, Mode, Effects, and Analysis (FMEA), data gathering, and reporting on cases based on set criteria to troubleshoot difficult, complex cases, new technology requests, DCS Management system efforts, and other quality strategies for quality improvement.
- Communicates with clinical/non-clinical staff, healthcare providers, and other healthcare professionals to gather, provide education, report, and contribute to continuous improvement as the Quality Department's subject matter expert in areas of Behavioral Healthcare and Physical Healthcare.
- Manages and responds appropriately to requests in the Quality Inbox.
- Presents on materials that are quality specific in areas of quality as needed.
- Interprets and applies statutes, regulations, and Arizona Health Care Cost Containment System (AHCCCS) policy and rules; completes audits, performance review reporting, AHCCCS requests, Healthcare Effectiveness Data and Information Set (HEDIS) reports, accreditation reports, and other reports required from the Quality Department or as support to other areas within the DCS CHP.
- Participates and/or available telephonically for periods beyond regular work hours on a rotational basis; handles incoming telephonic inquiries from pharmacies, members, providers, caregivers, and DCS staff during off-hours.
- Participates in compliance and accreditation activities, as appropriate.
- Participates in committees as assigned.
- Knowledge of DCS policies, procedures, and current State, Federal, and local laws governing AHCCCS/Medicaid health plan operations and requirements.
- Knowledge of Behavioral Health Systems tailored to children under the age of 18 years old.
- Knowledge of Healthcare administration as it relates to children in foster care.
- Knowledge of Quality Healthcare practices.
- Knowledge of Quality of Care Concerns (QOC) and Incident, Accident, and Death reporting (IAD).
- Knowledge of Clinical standards and quality of care.
- Knowledge of Quality structure, performance improvement, safety, and data analysis.
- Knowledge of Healthcare Plan Accreditation.
- Knowledge of Microsoft applications.
- Skills in oral and written communication.
- Skills in clinical problem-solving.
- Skills in clinical management and leadership practices.
- Skills in interpersonal, community, and group relations.
- Skills in organizing and administering health plans.
- Ability to plan, organize, and evaluate clinical care coordination within Arizona's systems of care; the foster care system, and related agencies.
- Ability to contribute to maintain up-to-date knowledge of agency and department policies and procedures.
- Ability to understand the importance of and respect for the confidentiality of member information in accordance with applicable standards and regulations.
- Ability to clearly identify problem, analyze situation, and rectify quality of care concerns.
- Ability to work under pressure in a high-pace environment.
Experience in pediatric healthcare; managed care with familiarity of Arizona's healthcare programs, including state and local resources. Healthcare quality-specific experience and health plan experience.
Pre-Employment Requirements:Must be able to secure and maintain an Arizona Fingerprint Clearance Card.
Must be able to secure and maintain clearance from DCS Central Registry.
Current, active AZ RN license; in good standing with AZ Nursing Board.
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:
All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).
Benefits:The State of Arizona provides an excellent comprehensive benefits package including:
- Affordable medical, dental, life, and short-term disability insurance plans.
- Top-ranked retirement and long-term disability plans.
- 10 paid holidays per year.
- Vacation time accrued at 4.00 hours bi-weekly for the first 3 years.
- Sick time accrued at 3.70 hours bi-weekly.
- Deferred compensation plan.
- Wellness plans.
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 website.
Retirement:Positions in this classification participate in the Arizona State Retirement System (ASRS). Enrollment eligibility will become effective after 27 weeks of employment.
-
Healthcare Quality Manager
1 month ago
Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full timeJob Summary:This nursing position is responsible for leading the Department of Child Safety's (DCS) Comprehensive Health Plan (CHP) clinical and quality contributions as the subject matter expert for the DCS CHP Quality Department. The role promotes quality and cost-effectiveness of healthcare by applying clinical acumen and the appropriate application of...
-
Healthcare Quality Manager
4 weeks ago
Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full timeJob Summary:This position is responsible for leading the Department of Child Safety's (DCS) Comprehensive Health Plan (CHP) clinical and quality contributions as the subject matter expert for the DCS CHP Quality Department. The role promotes quality and cost-effectiveness of healthcare by applying clinical acumen and the appropriate application of State and...
-
Healthcare Quality Manager
1 month ago
Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full timeJob Summary:This position is responsible for leading the Department of Child Safety's (DCS) Comprehensive Health Plan (CHP) clinical and quality contributions as the subject matter expert for the DCS CHP Quality Department. The role promotes quality and cost-effectiveness of healthcare by applying clinical acumen and the appropriate application of State and...
-
Healthcare Quality Manager
2 weeks ago
Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full timeJob Summary:This position is responsible for leading the Department of Child Safety's (DCS) Comprehensive Health Plan (CHP) clinical and quality contributions as the subject matter expert for the DCS CHP Quality Department. The role promotes quality and cost-effectiveness of healthcare by applying clinical acumen and the appropriate application of State and...
-
Healthcare Quality Specialist
4 weeks ago
Phoenix, Arizona, United States Banner Health Full timeJob SummaryThis role coordinates the investigation of quality of care concerns for Banner University Health Plan members referred to the Quality Management Department for review and resolution.Key ResponsibilitiesInvestigate referred Quality of Care concerns, including medical record documentation review, obtaining provider responses, and preparing...
-
Senior Quality Assurance Manager
3 days ago
Phoenix, Arizona, United States Quality Technology Services, LLC Full timeJob SummaryWe are seeking a highly skilled and experienced Quality Assurance Manager to lead our quality assurance programs and ensure the highest standards of quality in our data center operations. The successful candidate will have a strong background in quality assurance, project management, and construction, with excellent communication and leadership...
-
Healthcare Operations Manager
3 weeks ago
Phoenix, Arizona, United States Serenity Healthcare Full timeAbout the RoleWe are seeking an experienced and compassionate Assistant Manager to join our team at Serenity Healthcare. As a key member of our clinical operations team, you will play a vital role in delivering exceptional patient care and driving business growth.Key ResponsibilitiesLead the coordination of patient care services, ensuring seamless delivery...
-
Quality Assurance Senior Project Manager
2 weeks ago
Phoenix, Arizona, United States Quality Technology Services, LLC Full timeJob Title: Quality Assurance Senior Project ManagerAt Quality Technology Services, LLC, we are seeking a highly skilled Quality Assurance Senior Project Manager to join our team. As a key member of our organization, you will be responsible for leading the development and implementation of project-specific quality programs in alignment with our Quality...
-
Healthcare Manager
3 days ago
Phoenix, Arizona, United States Triwest Healthcare Full timeJob SummaryWe are seeking a highly skilled and experienced Healthcare Manager to lead our Case Management Specialty Programs team. As a key member of our team, you will be responsible for overseeing the day-to-day operations of the program, ensuring compliance with contract requirements, and developing and implementing strategies to optimize case management...
-
Healthcare Quality Specialist
2 days ago
Phoenix, Arizona, United States Banner Health Full timeJob SummaryThis position plays a critical role in ensuring the highest quality of care for Banner University Health Plan members. As a Quality of Care Coordinator, you will investigate and resolve quality of care concerns, working closely with providers and other stakeholders to identify and address potential issues.Key ResponsibilitiesInvestigate and...
-
Healthcare Operations Manager
4 weeks ago
Phoenix, Arizona, United States Serenity Healthcare Full timeAbout the RoleWe are seeking a highly skilled and motivated Operations Manager to join our team at Serenity Healthcare. As a key member of our leadership team, you will be responsible for leading our operations and ensuring the delivery of exceptional patient experiences and outcomes.Key Responsibilities:Lead a team to provide exceptional patient experience...
-
Healthcare Quality Improvement Specialist
3 days ago
Phoenix, Arizona, United States Health Services Advisory Group Full timeTransforming Healthcare through Performance MeasurementHealth Services Advisory Group (HSAG) is a nationally recognized leader in healthcare performance measurement, and we are seeking a talented Auditor III to join our team. As a key member of our Audits department, you will play a critical role in improving the quality of healthcare by leading performance...
-
Quality Assurance Manager
2 weeks ago
Phoenix, Arizona, United States B. Braun Medical Inc Full timeAbout B. Braun Medical Inc.B. Braun Medical Inc. is a leading manufacturer of medical products and services. Our company is committed to providing high-quality products and services to the healthcare industry.Job SummaryWe are seeking a Quality Assurance Manager to join our team. The successful candidate will be responsible for managing quality assurance...
-
Healthcare Facility Manager
4 weeks ago
Phoenix, Arizona, United States Infusion4Health Inc Full timeJob Title: Healthcare Facility ManagerInfusion for Health is seeking a skilled Healthcare Facility Manager to oversee the operation of our clinics across multiple states. As a key member of our team, you will be responsible for ensuring the smooth and efficient management of our healthcare facilities, providing a safe and welcoming environment for patients...
-
Quality Assurance Manager
3 weeks ago
Phoenix, Arizona, United States B. Braun Medical Inc Full timeAbout B. Braun Medical Inc.B. Braun Medical Inc. is a leading manufacturer of medical products and services, committed to delivering high-quality solutions to the healthcare industry. Our company is dedicated to eliminating preventable treatment errors and enhancing patient, clinician, and environmental safety.Job Summary:We are seeking a highly skilled...
-
Healthcare Project Manager
2 weeks ago
Phoenix, Arizona, United States Okland Construction Full timeJob Title: Healthcare Project ManagerWe are seeking an experienced Healthcare Project Manager to lead our commercial construction projects in the healthcare sector. As a key member of our team, you will be responsible for ensuring that projects are completed on time, within budget, and to the highest quality standards.Key Responsibilities:Manage and...
-
Quality Assurance Manager
1 week ago
Phoenix, Arizona, United States B. Braun Medical Inc Full timeAbout B. Braun Medical Inc.B. Braun Medical Inc. is a leading manufacturer of medical products and services. Our company is committed to providing high-quality products and services to the healthcare industry.Job SummaryWe are seeking a Quality Assurance Manager to join our team. The successful candidate will be responsible for managing quality assurance...
-
Quality Manager
3 days ago
Phoenix, Arizona, United States UCT Alumni Association Full timeJoin the Fastest-Growing Sector in the WorldAt Ultra Clean Technology, we're revolutionizing the semiconductor industry with cutting-edge technology and innovative solutions. As a Quality Manager, you'll play a critical role in ensuring our products meet the highest standards of quality and reliability.Key Responsibilities:Develop and maintain quality plans...
-
Senior Quality Improvement Specialist
3 days ago
Phoenix, Arizona, United States Molina Healthcare Full timeJob Title: Senior Specialist, Quality Interventions/QI ComplianceMolina Healthcare is seeking a highly skilled Senior Specialist, Quality Interventions/QI Compliance to join our team. This role will be responsible for overseeing, planning, and implementing new and existing healthcare quality improvement initiatives and education programs.Key...
-
Healthcare Claims Analyst
3 weeks ago
Phoenix, Arizona, United States Triwest Healthcare Full timeJob SummaryThe Coding and Reimbursement Analyst plays a critical role in ensuring claims payment accuracy and waste reduction initiatives by collecting, aggregating, and analyzing claims data from multiple systems.Key ResponsibilitiesCollect and analyze claims data to identify trends and patterns.Develop and maintain reports to communicate findings to...