Compliance and Quality Assurance Manager

5 days ago


Phoenix, Arizona, United States Southwest Human Development Inc Full time
Job Title: Compliance and Quality Assurance Manager

Job Summary:

The Compliance and Quality Assurance Manager will oversee the department's compliance program to ensure employees comply with the rules and regulations of governing regulatory agencies, and departmental and agency policies. This role will create and own processes for quickly identifying and correcting policies and procedures not being followed.

Key Responsibilities:

  • Compliance Program Oversight: Lead the charge in preparing for regulatory audits, reviews, reports, studies, and site visits, ensuring our department exceeds regulatory expectations.
  • Collaboration and Partnership Building: Collaborate closely with our HIPAA compliance officer to safeguard client-protected health information, upholding the utmost confidentiality and trust. Be the face of our organization in regional health plan meetings, liaising with contractors and stakeholders to foster strong, compliant partnerships.
  • Compliance Monitoring and Coordination: Monitor and coordinate compliance activities, providing vital status updates and identifying trends to keep us ahead of the curve.
  • Proactive Compliance: Proactively identify areas of compliance vulnerability, crafting and implementing corrective action plans to resolve issues and prevent future occurrences.
  • Training and Development: Manage and leverage our Learning Management Platforms, ensuring training requirements are met with efficiency and effectiveness.
  • Provider Credentialing: Oversee the provider credentialing process, maintaining the highest standards of qualification and excellence.
  • Policy Management: Maintain and manage our policy library, ensuring all documentation is up-to-date and in line with organizational and program leadership directives.

Quality Program Oversight:

  • Quality Program Development: Take the lead in developing, implementing, and overseeing a robust quality program, designed to elevate clinical performance and meet internal and regulatory goals.
  • Strategic Support: Provide strategic support to achieve quality and department goals, identifying and implementing performance quality improvement efforts.
  • Key Performance Indicators: Establish and monitor key performance indicators, ensuring progress toward contractual metric targets and departmental objectives.
  • Project Implementation: Manage project implementation related to new data, performance improvement, or regulatory requirements, ensuring seamless integration and success.
  • Quality Improvement Strategies: Develop and execute short- and long-term strategies, implementing quality improvement suggestions to meet and exceed contractual requirements and KPIs.
  • Industry Standards: Play a pivotal role in quality improvement projects and campaigns, leading the way in setting industry standards.

Requirements:

  • Education: MA/MS – healthcare field, healthcare administration, social services, related field of study
  • Experience: Minimum of five (5) years experience in the healthcare industry with responsibility for quality improvement, data analysis and outcome measures. This includes a demonstrated ability to develop, implement, and manage a quality management program.
  • Requirements: Experience working with electronic record systems (EMR/EHR) – comprehensive applications, data management and reporting. Value-based programming and payment experience. Medicaid (specifically AHCCCS) experience.
  • Preferred Qualifications: A strong background in health field areas, including medical and behavioral health experience, with a deep understanding of quality improvement strategies is preferred for this position.
  • Leadership Qualities: Demonstrated leadership qualities through collaboration and teamwork experience.
  • Skills: Strong organization, critical thinking, problem-solving, and communication skills. Proficient in the Microsoft Office Suite: Excel, Word, etc.


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