Quality Management Manager

The Quality Management Manager oversees quality improvement activities and interventions to improve outcomes for identified quality measures.  This role implements a structured quality management program to drive and ensure continuous quality improvement within the organization, working with the Vice President of QM & Compliance to continue and improve the agency's Quality Management Plan, annual report of QM goals, and QM policies.

• Develops and manages process improvement activities and corrective action plans, to address trends identified through practice reviews, complaints/grievances, or quality of care matters as applicable to payer/state audits
• Review of substantiated complaints/grievances and back up to the QM department to receive client complaints.
• Supervision and oversight of the QM Analyst position(s) and facilitation of the Quality Assurance Committee.
• Implements internal controls to ensure the agency is meeting or exceeding benchmark standards for medical record reviews (e.g. audits) and compliance with AHCCCS and ADHS outpatient medical record standards.
• Responsible to ensure QM department deliverables are completed timely and accurately and submitted to appropriate payers.
• Support to the clinical departments and compliance in review of record requests and subpoenas.
• Is able to apply knowledge of AHCCCS/ADHS/RBHA/payer and the Council of Accreditation requirements to maintain current and up to date QM procedures and standards
• Works across departments to support the agency in analyzing, updating, and modifying standard operating procedures and processes to continually improve services and operations for an efficient and positive client and staff experience
• Establishes professional relationships with stakeholders and community agencies. Attends Joint Operations Committee meetings and other necessary health plan meetings
• Conducts the agency survey process for members and stakeholders, including the analyzing and sharing of survey results with leadership and board members.
• Oversees the completion of mortality assessments in coordination with the Medical Director and Vice President of QM and Compliance, aimed at identifying individual or systemic areas of risk that would benefit from process improvement
• Knowledge of federal and state Culturally and Linguistically Appropriate standards (CLAS) and serves as co-facilitator of the agency Cultural Competency Committee and Cultural Competency Plan.

Key Performance Indicators

• The QM Manager and team will be responsible to translate data into a meaningful story and points of action, that are shared with clinic directors and program leadership through data reports, committee, and other various methods
• Develops and implements systems & procedures for the identification, collection, analysis, and sharing of performance measurement and contractually required data (e.g. deliverables)
• Stays up to date with health plan and other regulatory requirements and effectively disseminates this information within the agency and facilitates necessary changes
• Serves as project lead for QM assigned initiatives and projects, developing project plans, adhering to deadlines, contributing to policy and training modifications
• Ensures internal controls are implemented across varying levels of staff and takes action on trends requiring improvement

• Bachelor’s Degree in related field required
• Master’s Degree preferred
• Experience in a quality management role within a healthcare setting or in a similarly situated environment preferred.
• Three years of experience in behavioral health or related field and knowledge of AHCCCS/ADHS, RBHA and COA accreditation standards required in a quality management program
• Capacity to analyze, evaluate and problem solve issues surrounding client care and service delivery
• Acknowledgement of and sensitivity to Culturally and Linguistically Appropriate Services in a culturally and diverse environment of integrated health is required
• A solutions-oriented approach to problems and issues as well as discretion in judgement and communications are required traits for this position
• Ability to communicate clearly and effectively through verbal and written methods
• An attitude of significant respect for all people regardless of national origin, race, religion, sex, sexual orientation, gender preference is required in this position