Clinical Quality Management Coordinator
Our Mission: Provide the best value in health insurance and related health services to improve the quality of life for Arizonans.
Inspire health in Arizona as the trusted leader in delivering affordable, innovative healthcare solutions.
Our Benefits: Our benefits provide work-life balance and the flexibility you need to be your best. We offer comprehensive medical, dental, and vision coverage; a 401K savings plan; paid holidays and vacations; and much more!
The Clinical Quality Improvement Coordinator is responsible for supporting, evaluating the practices of, and recommending improvement actions to Behavioral Health and Primary Care Providers across the provider network related to Quality of Care Concerns, SMI Grievances, Audits, and other internal or external referral sources. These actions will support the HCA Quality Management Committee, Morbidity and Mortality Committee, and Peer Review Committee, as well as the goals and benchmarks detailed in the annual Quality Management Plan.
- Analyzes and evaluates performance improvement data to identify trends in quality of care concerns, member complaints, grievances and other quality referral sources
- Reviews quality of care data in depth to determine whether performance improvement activities are required to improve agency effectiveness and patient outcomes
- Initiates performance improvement activities of varying degrees of intensity with providers and/or provider agencies based on specific issues identified within the system of care. These activities include technical assistance meetings, letters of concern, and corrective action plans
- Coordinates and collaborates with the Medical Directors, subject matter experts, and other HCIC departments to identify areas in need of improvement within a system of care and determine appropriate performance improvement approaches for specific issues
- Coordinates on and off-site performance improvement meetings with providers to facilitate the performance improvement process
- Maintains and tracks performance improvement activities and deliverables to confirm that the changes brought about through performance improvement activities are maintained
- Ensures providers are in compliance with HCIC contractual obligations, the HCIC provider policy manual, Arizona statutes, and other federal and state behavioral health regulations
- Performs other duties of a similar nature and level as assigned
- Current AZ driver’s license as some travel required
Education / Experience / Other Requirements
- Bachelor's degree in healthcare field, behavioral health is preferred, or an equivalent combination of education and experience sufficient to successfully perform the essential duties of this position
Years of Experience:
- 2-3 years of experience in Healthcare Quality Management or Performance Improvement Understanding of Acute Healthcare and Behavioral Healthcare Service Delivery
- Knowledge of quality metrics and risk adjustment preferred
- Knowledge of AHCCCS contract requirements, policies, and procedures; federal and state behavioral health regulations; continuous quality improvement practices; program evaluation; and project management
- Qualification, or ability to be qualified, as a Certified Professional in Healthcare Quality (CPHQ) is preferred
- Lean Six Sigma Green Belt or higher is preferred