Job: DDD Quality Management Administrator(Job Id 33435)

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Job Description

10/06/2017 10/20/2017
HEALTHCARE PROFESSIONALS 25
PHOENIX 70,720.00-89,440.00

Department of Economic Security

Providing Opportunity, Assistance and Care for Arizonans in need!

DDD Quality Management Administrator

Division of Developmental Disabilities

3443 North Central Avenue

Phoenix, AZ 85012

www.azdes.gov

JOB SUMMARY:

The Division of Developmental Disabilities (DDD) Quality Management Administrator reviews clinical records regarding diagnosis, treatment, and summary of the member’s progress. This position ensures individual and systematic quality of care and confers with other practitioners and technical experts in own field of specialization. The Quality Management Administrator conducts on-site quality management visits/reviews.

JOB DUTIES: 

-        Provide leadership in ongoing development and implementation of a data-based monitoring, tracking and process improvement system that will ensure compliance with the Arizona Health Care Cost Containment System (AHCCCS) requirements for quality management.  Lead and supervise activities that investigate and review all member deaths; track and trend all incidents and accidents; investigate, issue, resolve, track and trend to resolution all quality of care concerns and grievances; and monitor the Division's compliance with AHCCCS performance measures, including access to care, coordination of care, appropriateness of services, sufficiency of assessments, and customer satisfaction.

-        Ensures review of 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 knowledge, acquired.  Facilitates the attainment of Division goals and objectives to promote optimal contract and Centers for Medicare and Medicaid Services (CMS) compliance and provides leadership and education to Division staff.  Implements process improvement and integrates quality throughout the organization.

-        Fosters teamwork, personal responsibility, integrity, innovation, trust, and communication by contributing to the enhancement of group effectiveness by exchanging information, collaborating with other team members, and providing constructive feedback.  Listens attentively to members/families to ensure understanding and delivery of personalized services.  Conducts on-site quality management visits/reviews.

-        Assures regulatory compliance within assigned areas of responsibilities and in collaboration with Assistant Director and peers.  Establishes external networks to facilitate benchmarking and practice excellence.  Demonstrates leadership within and outside the Division to promote a model of excellence in practice, education, and administration.  Maintains active and current general knowledge of the practice.

-        Ensures that review of medical records for quality of care issues, compliance with best practices, and potential litigation concerns occurs as needed.  Conducts Care Need Today/Immediate Jeopardy investigations.  May be requested to assist Attorney General's Office with litigation review or expert testimony.

-        Assists with or complete Letters of Concern, Notice to Cure, or Demand for Assurance corrective actions to providers, review corrective action plans, respond in writing to providers related to review of corrective action plans.  Ensures a credentialed provider network. Participates in the Division's executive management team.  Provides input along with the senior management team and assists with the strategic planning for the Division.  Meets regularly with internal management staff and external stakeholders including the Attorney General's Office and other state agencies.

 

KNOWLEDGE, SKILLS AND ABILITIES (KSAs):

Knowledge of:

-        Federal Regulations related to Medicaid, Medicare, Federal and State laws, agency rules, policies and procedures for medical services in a managed care environment.

-        Applicable laws, rules, policies, procedures and standards related to acute care delivery, nursing scope of practice, quality assurance, and quality management principles.

-        Principles of group dynamics, relationships, and human development with regards to 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.

Skill in:

-        Using computer systems including electronic medical record, word processing, spreadsheet and data base applications.

-        Project leadership and coordination experience.

-        Analyzing situations accurately and taking effective action.

-        Problem solving, decision-making, continuous improvement and financial accountability.

Ability to:

-        Communicate effectively, work cooperatively with others, and work independently with minimal supervision.

-        Establish and maintain working relationships.

-        Manage workload while demonstrating the outstanding ability to write reports, policies and procedures.

-        Design effective plans for program improvement.

SELECTIVE PREFERENCE(S):

-        Must possess an active current Registered Nursing License in 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 and 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).

-        Driving is required.  Individuals may be required to use their personal motor vehicle.

PRE-EMPLOYMENT REQUIREMENTS: 

-        Valid Driver’s License

-        Valid Professional License

BENEFITS: 

 The Department of Economic Security offers a comprehensive benefits package to include: 

-        Sick leave

-        Vacation with 10 paid holidays per year

-        Health and dental insurance

-        Retirement plan

-        Life insurance and long-term disability insurance

-        Optional employee benefits include short-term disability insurance, deferred compensation plans, and supplemental life insurance

RETIREMENT: 

Positions in this classification participate in the Arizona State Retirement System (ASRS). 

Please note, enrollment eligibility will become effective after 27 weeks of employment.

CONTACT US: 

If you have any questions please feel free to contact 602-542-6883 for assistance.

Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by contacting 602-364-3981. Requests should be made as early as possible to allow time to arrange the accommodation. Arizona State Government is an AA/EOE/ADA Reasonable Accommodation Employer.