Job Summary
The Manager AR Home (Medicaid) Quality directs programs for all quality measures. The incumbent collaborates with higher level leadership to develop the strategy for appropriate measures and implements programs to support meeting state requirements. The Manager is responsible for keeping the team focused on project documentation and implementation while collaborating with internal teams, vendors, and key state providers to support strategic development, drive program success, enhance analytics, and achieve quality program outcomes.

Requirements

EDUCATION

Bachelor's Degree in Business or a Medical background. In lieu of degree, five (5) years' experience engaging with physicians and health care providers required in addition to the experience requirements listed below.

EXPERIENCE & KNOWLEDGE

Minimum five (5) years' experience engaging with physicians and health care providers.

Minimum two (2) years' experience with government programs quality measure/program experience in Medicare (HEDIS, CMS Quality measures).

Minimum two (2) years' experience related to regulatory requirements.

Minimum two (2) years' leadership experience (role, project management, team leader, etc.)

Experience working with Microsoft Office (Excel, Access, etc.).

Experience working with healthcare claims data.

Knowledge of Medicaid/Government Programs preferred.

Knowledge of Arkansas clinical quality, physician, and pharmacy landscape preferred.

Skills
• Activity Coordination• Analyze Information• Coaching Others• Continuous Learning• Cross-Functional Communications• Decision Making• Employee Engagement Strategies• Evaluating Information• Interpersonal Communication• Interpersonal Relationships• Management Techniques• Monitor Processes, Materials, or Surroundings• Object Identification• Organizing• Public Relations (PR) Management• Service Oriented

Responsibilities
• Collaborates with other internal departments as necessary.• Collaborates with team to prepare reporting and documentation for updates to state Medicaid department and other team members.• Completes intervention outreach to members, as needed, for specified Medicaid measures or escalated cases from Clinical Outreach team.• Develops, implements, and manages performance improvement of Medicaid quality program while identifying and articulating results, barriers, and opportunities.• Drives the strategic direction and development of outreach programs at both the portfolio and initiative levels, ensuring compliance with Medicaid quality standards while improving outcomes across preventive screenings, medication management, behavioral health interventions, and appropriate clinical follow-up.• Manages budgets and staffing for interventions in collaboration.• Manages hiring, coaching, training, employee development, and performance management of team.• Partners with Healthcare Effectiveness Data and Information Set (HEDIS) Director and Education Manager to develop collaborative programs for clinical measure to educate providers and abstract medical records.• Performs other duties as assigned.• Provides clinical guidance, support and oversight to the assigned Medicaid teams.• Works with vendors and cross disciplinary teams to coordinate activities and oversees the collection, analysis, reporting and trending of data relative to Medicaid performance, outcomes and return on investment of intervention activities.

Certifications

Security Requirements

This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties

Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

Employment Type
Regular

ADA Requirements

1.1 General Office Worker, Sedentary, Campus Travel - Someone who normally works in an office setting or remotely and routinely travels for work within walking distance of location of primary work assignment.