Healthcare Quality Manager

2 weeks ago


Phoenix, Arizona, United States Arizona Official Website of State of Arizona Full time
Job 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 Federal policies, evidence-based criteria, and guidelines.

Key Responsibilities:
  • Contribute to individual and systemic quality of care for the DCS CHP Quality Department.
  • Perform medical necessity reviews, investigations, and follow-up of quality-of-care concerns, complaints, and grievances.
  • Conduct on-site quality management required visits and/or reviews as needed.
  • Reports, tracks, and trends, resolves various measures for quality improvement department-wide.
  • Communicate with clinical/non-clinical staff, healthcare providers, and other healthcare professionals to gather, provide education, report, and contribute to continuous improvement.
  • Manage and respond appropriately to requests in the Quality Inbox.
  • Interpret and apply statutes, regulations, and Arizona Health Care Cost Containment System (AHCCCS) policy and rules.
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:
  • 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.


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