Healthcare Quality Manager

3 days ago

Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full time
Job 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 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, Skills & Abilities (KSAs):
  • 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.
Preferred Qualifications:

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.

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