Clinical Program Director

6 days ago

Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full time
Job Summary:

This nursing position is responsible for 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. Responsibilities include leading, evaluating, investigating, monitoring, providing oversight and coordination for behavioral, dental and physical health services for children in foster care throughout the state of Arizona.

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, as appropriate. This role requires research, data analysis, data interpretation and the utilization of quality tools for contributions for continuous improvement.

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.

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.
  • 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 with ability to communicate results.
  • 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; handle 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.
  • Other duties as assigned as related to the position.
Knowledge, Skills & Abilities (KSAs):
  • Knowledge of DCS policies, procedures, and current State, Federal and local laws governing AHCCCS/Medicaid health plan operations and requirements.
  • Behavioral Health Systems tailored to children under the age of 18 years old.
  • Healthcare administration as it relates to children in foster care.
  • Quality Healthcare practices.
  • Quality of Care Concerns (QOC) and Incident, Accident and Death reporting (IAD).
  • Clinical standards and quality of care.
  • Quality structure, performance improvement, safety and data analysis.
  • Healthcare Plan Accreditation.
  • Microsoft applications.
Skills in:
  • Oral and written communication.
  • Clinical problem solving.
  • Clinical management and leadership practices.
  • Interpersonal, community and group relations.
  • 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.
  • Contribute to maintain up-to-date knowledge of agency and department policies and procedures.
  • Understand importance of and respect for the confidentiality of member information in accordance with applicable standards and regulations.
  • Clearly identify problem, analyze situation, and rectify quality of care concerns.
  • Work under pressure in a high pace environment.
Selective Preference(s):

Experience in pediatric healthcare; managed care with familiarity of Arizona's healthcare programs, including state and local resources. Health care 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.

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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