- Federal Regulations related to Medicaid, Medicare, Federal and State laws, agency rules, policies and procedures for medical services in a managed care environment
- Quality Management principles Applicable laws, rules, policies, procedures and standards related to acute care delivery, nursing scope of practice, and quality assurance
- Principles of group dynamics, relationships, and human development Developmental disabilities and Division philosophy of service provision
- Arizona Health Care Cost Containment System (AHCCCS), Department of Health Services, and Centers for Medicare and Medicaid
- The integrated health care system (ALTCS-DDD, BH, ACUTE AND CRS)
- Quality Improvement Project techniques or methodologies, such as:
- Rapid Cycle – PDSA Plan, Do, Study, Act or PDCA Plan, Do, Check, Act.
- Advanced Implementation Quality Planning
- Affinity Diagram
- Five Whys and Five Hows
- The use of clinical data for healthcare quality measurement, reporting, evaluation, and improvement and how these outcomes can be integrated into new models of care
- Computer skills including electronic medical record, word processing, spreadsheet and data base applications
- Project leadership and coordination experience
- Analyzing situations accurately and taking effective action
- Researching and developing a successful model of quality improvement initiatives that lead to better health care outcomes for the DDD members
- Solid communication skills (written and verbal) including the ability to concisely explain complicated concepts to leadership and staff within and outside of the agency
- Leading the effort to develop the resources, or infrastructure needed to support quality improvement programs
- Communicating the strategic vision, scope and mission of the DDD throughout the implementation of QM initiatives
- Measuring and evaluating data to determine the impact of the DDD programs on both the LTSS and the integrated health systems
- Problem solve, decision-making, continuous improvement and financial accountability
- Communicate effectively, work cooperatively with others, and work independently with minimal supervision
- Establish and maintain working relationships Write reports, policies and procedures
- Design effective plans for program improvement
- Manage workload
- Ability to read, analyze, and interpret the most complex documents, contractual provisions and rules.
- Ability to delegate or respond effectively to sensitive inquiries and complaints including quality of care concern investigations.
- Ability to write technical and non-technical documents using original or innovative techniques ensuring the QM plan is communicated throughout DDD
- Ability to make effective and persuasive presentations on complex topics to leadership stakeholders, providers, state agencies, members and their families
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Active current Registered Nursing Licensein the state of Arizona
- physician or physician's assistant or a Certified Professional in Healthcare Quality (CPHQ) by the National Association for Health Care Quality (NAHQ) and/or Certified in Health Care Quality
- Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers.
In accordance with the Arizona Health Care Cost Containment System contract as defined in 42 CFR 455,104, SMDL #09-001) a search for the incumbent will be conducted monthly using the List of Excluded Individuals and Entities (LEIE) and the System for Award Management (SAM).
In-state travel may be required. This position requires possession of and ability to retain a current, valid state-issued driver's license appropriate to the assignment. Employees who drive on state business are subject to driver's license record checks, must maintain acceptable driving records and must complete any
Reviews clinical records regarding diagnosis, treatment and summary of member's progress. Ensures individual and systemic quality of care. Confers with other practitioners and technical experts in own field of specialization, in order to broaden knowledge, acquire specific information, or obtain advice or consultation. Performs related work as required. Acts as a steward of resource to achieve goals aligned with program direction. Implements process improvement and integrates quality throughout the organization. Collaborates with the Assistant Director and other Division staff to develop programs. Assures regulatory compliance within assigned areas of responsibilities and in collaboration with Assistant Director and peers. Establishes external networks to facilitate benchmarking and practice, education, and administration. Ensures a credentialed provider network. Maintains active and current general knowledge of the practice. Identifies redundant activities, integrates processes and leads initiatives that will allow the Division to accomplish and sustain compliance. Develops and submits the annual Quality Management Plan, Medical Management/Utilization Management Plan, Maternity/EPSDT, and Behavioral Health Plan and monitors progress of established work plans. Coordinates all activities for the annual Operational Financial Review which requires careful coordination, file submission review prior to finalization of the submission, and coordination amongst all departments such as business operations, health care services, case management, and the office of compliance and review to meet the designated time lines for prompt and comprehensive submission of documents. Assists with or develops all Letters of Concern, Notice to Cure, or Demand for Assurance and assures communication of these corrective actions with the Districts, Business Office, and Contracts Department. Conducts comprehensive quality-of-care and Care Needed Today/Immediate Jeopardy investigations. Resolves, tracks and trends quality of care grievances. Confers with the Attorney General Office for all matters related to corrective actions or potential or actual litigation activities. Assists State Operated programs with review or policy development and assist with staffing complicated cases or reviewing quality issues involving medical services. Conducts onsite quality management visits/reviews.