Address:  801 E. Jefferson Street, Phoenix, AZ 85034

Salary: $70,400

Grade: 21

Open Until Filled

Under the leadership of the Quality Management Manager and Quality Management Supervisor, this position participates in the oversight of quality management structure within the statewide managed care delivery system. This position will be primarily virtual with some in-office meetings and on-site investigations and reviews as needed. This position will also participate as needed in on-site investigations and reviews outside of normal business hours and weekends.
This position is responsible for the oversight and review of the quality-of-care concern investigation process involving behavioral health services and providers. The position is responsible for understanding the needs of stakeholders especially those of members with unmet health care needs, members diagnosed with developmental delays, members diagnosed with behavioral health conditions, members with special health care needs and families of children with special health care needs.
This position will work directly with all AHCCCS populations in a managed care structure, including physical health, behavioral health, and LTC Supports and Services. The position ensures acknowledgment of receipt of issues for investigation to members, AHCCCS Administration, the Governor's office, legislators and other advocacy groups to ensure that member issues and concerns have been investigated and resolved.
The position is responsible for increasing member satisfaction and improving risk management efforts for AHCCCS by resolution of quality-of-care complaints in a timely and comprehensive manner. Direct clinical knowledge and expertise is applied by this position in review and timely resolution of the cases assigned and to identify systemic issues for AHCCCS to address.

Major duties and responsibilities include but are not limited to:
• Receive, research, document, and resolve quality of care issues utilizing standardized processes and centralized databases. Track, trend, and monitor status of cases to ensure thorough and timely completion as well as appropriate referrals. Primary emphasis will be placed on special populations such as those utilizing behavioral health services.
• Ensure research and resolution of quality-of-care issues in a timely manner as assigned and identify systemic issues for AHCCCS to address.
• Participate in operational reviews, technical assistance, and focused studies/reviews, including the behavioral health delivery system, to ensure compliance with contractual and policy requirements for all lines of business. Follow-up on written reports, corrective action plans, notices to cure and sanctions as appropriate.
• Ensure quality of care to AHCCCS members, including ensuring member health and safety as well as dignity and respect. Focus on unique aspects of each case, individual care needs, timely correspondence with members, and timely acknowledgment of concerns as well as resolution of the issue. Use appropriate judgment regarding data to research, regulatory referrals, status level, interventions, and appropriate resolution.
• Provide technical assistance to Contractors, as appropriate, regarding contractual and/or policy requirements to improve quality of care and service delivery to AHCCCS members.
• Participate in special projects and reviews as assigned and assure completion within the designated timelines. Provide ongoing updates to CQM Management.
• Coordinate and complete tracking, evaluation, and response to Contractor deliverables.
• Participate in the development of improved processes and procedures to improve efficiency of the CQM Unit.
• Participate in on-site visits to conduct QM investigations and reviews regarding possible health and safety concerns, immediate jeopardy situations and other situations supporting AHCCCS initiatives and ventures. Onsite visits may also occur outside of normal business hours and weekends.

Knowledge:
• Structure and operation of the Arizona behavioral health system
• SMI grievance and administrative appeal processes; rules, status and regulations that define the standards of care applicable to the behavioral health system
• State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, Behavioral Health, LTC and Tribal and Children’s Rehabilitative Services
• Behavioral health services, case management protocols, utilization review protocols as related to assigned populations (e.g. Acute, behavioral health, Long Term Care)
• Current standards of medical/ behavioral practice and modes of delivery for acute and non-acute medical/behavioral care/services

Skills:
• Techniques to select a particular approach to analyze develop or implement a policy, project management methodologies and Behavioral Health delivery system
• Strong interpersonal skills to effectively relate to AHCCCS members, their families, and Agency stakeholders
• Behavioral Health processes including assessment, treatment planning, intervention, and evaluation
• Understanding of and experience with special health care needs populations
• Strong interpersonal skills in working with agency management, and people of diverse cultures and socioeconomic backgrounds; project management to meet goals and deadlines

Abilities:
• Assess members from a holistic perspective with an emphasis on recognizing medical, social, environmental, and emotional conditions, barriers for meeting medical needs that interfere with the member’s ability to function at an optimal level
• Communicate orally and in writing with members, contractors, and providers to facilitate resolution or presenting issues
• Collaborate with others for mutually beneficial outcome to make effective decisions in a high volume fast paced environment, and strong organizational skills for setting priorities, workload and record keeping
• Read, interpret, and apply complex rules and regulations
• Work in a virtual environment

Minimum:
• Three years of management analyst experience appropriate to the assignment; OR five years of experience appropriate to the assignment. Bachelor's or Master's degree in a field appropriate to the assignment will substitute for one or two years of the required experience respectively but will not substitute for required management analysis experience.

Preferred:
• At least two-year professional healthcare industry experience in Quality or Utilization Management; OR five years of experience in the behavioral health field, preferably in the context of the delivery of service in Arizona’s public behavioral health system.
• Certified Professional Healthcare Quality.

• Successfully complete the Electronic Employment Eligibility Verification Program (E-Verify), applicable to all newly hired State employees.

• Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above-mentioned process and the agency’s ability to reasonably accommodate any restrictions.

• Travel will be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12.) AND have an acceptable driving record for the last 39 months including no DUI, suspension or revocations and less than 8 points on your license. If an Out of State Driver License was held within the last 39 months, a copy of your MVR (Motor Vehicle Record) is required prior to driving for State Business. Employees may be required to use their own transportation as well as maintaining valid motor vehicle insurance and current Arizona vehicle registration; however, mileage will be reimbursed.

If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Among the many benefits of a career with the State of Arizona, there are:
• 10 paid holidays per year
• Paid Vacation and Sick time off (13 and 12 days per year respectively) - start earning it your 1st day (prorated for part-time employees)
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
• Other Leaves - Bereavement, civic duty, and military.
• A top-ranked retirement program with lifetime pension benefits
• A robust and affordable insurance plan, including medical, dental, life, and disability insurance
• Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
• RideShare and Public Transit Subsidy
• A variety of learning and career development opportunities

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 here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Lifetime Pension Benefit Program
• Administered through the Arizona State Retirement System (ASRS)
• Defined benefit plan that provides for life-long income upon retirement.
• Required participation for Long-Term Disability (LTD) and ASRS Retirement plan.
• Pre-taxed payroll contributions begin after a 27-week waiting period (prior contributions may waive the waiting period).

Deferred Retirement Compensation Program
• Voluntary participation.
• Program administered through Nationwide.
• Tax-deferred retirement investments through payroll deductions.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.

Requests should be made as early as possible to allow time to arrange the accommodation. The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.