Qi/pi Manager - Phoenix, United States - State of Arizona

State of Arizona

Verified Company

Phoenix, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

DEPARTMENT OF ECONOMIC SECURITY

Your Partner For A Stronger Arizona. _
DES works with families, community organizations, advocates and state and federal partners to realize our collective vision: A thriving Arizona._
DES serves more than 3 million Arizonans. Our Mission is to strengthen individuals, families, and communities for a better quality of life._

QI/PI MANAGER

Job Location:

Address:
Division of Developmental Disabilities (DDD)
4000 North Central Avenue, Phoenix, Arizona 85012

Posting Details:

Salary:
$80, $86,300.00

Grade: 24

Closing Date:
June 3, 2024

Job Summary:

The Department of Economic Security, Division of Developmental Disabilities (DDD), is seeking an experienced and highly motivated individual to join our team as a Managed Care Program Administrator - QI/PI Manager.

This position is responsible for ensuring that the DOD participates in active and continuous performance improvement initiatives; contractually mandated Performance Measures (including the National Committee for Quality Assurance (NCQA), Healthcare Effectiveness Data and Information System (HEDIS) and the Center for Medicaid and Medicare Services (CMS) Core Measures), Performance Improvement Projects, and other activities of quality and performance improvement; data analysis to identify opportunities for improvement, demographic/health disparities, and assessment of effectiveness and sustained improvement.

Applicants for this position cannot be licensed or certified by the DDD Office of Licensing Certification and Regulation, cannot have a principal interest in or have a spouse or close family with principal interest in a DDD Qualified Vendor Agreement, and cannot be employed or subcontracted by a DDD Qualified Vendor.

This position may offer the ability to work remotely, within Arizona, based upon the department's business needs and continual meeting of expected performance measures.

The State of Arizona strives for a work culture that affords employees flexibility, autonomy, and trust.

Across our many agencies, boards, and commissions, many State employees participate in the State's Remote Work Program and are able to work remotely in their homes, in offices, and in hoteling spaces.

All work, including remote work, should be performed within Arizona unless an exception is properly authorized in advance.

Job Duties:
Essential Duties and Responsibilities include but not limited to:

Leads team in direct management of DOD specific performance evaluates sub-contractor performance. Responsible for implementation and oversight of initiatives that will directly impact achievement and/or sustainment of Minimum Performance Standards (MPS) outlined in Contract. Leads hybrid reviews and ensures sufficient quality checks of all submitted medical records and other supporting documentation.
Leads team to develop and select Performance Improvement Project (PIP) topics to evaluate clinical and nonclinical care related to specific or all populations. Develop and implement methodologies, develop data requests, review programming, perform quality checks on data samples, collect and analyze results, research best practices, interventions and activities to improve outcomes, and write and publish outcome reports.
Leads team in coordinating quality improvement initiatives. Lead analysis of data, facilitate identification of interventions, develop implementation plan, monitor implementation and report outcomes of quality improvement activities. Respond to data requests related to performance improvement projects.
Providing supervision, mentoring, and coaching of staff to ensure compliance with regulations and policies of the ODD.

Facilitating regular 1: 1 s, team huddles, and other communication modalities with the QI team. Completing Performance Appraisals, authorizing leave, and approving ETE Time Cards for staff.

Receives data, develops and runs system queries, conducts data analysis, and utilizes results to recommend quality improvement opportunities; identifies gaps, barriers and activities that are effective in improving care and services to members. Assess for disparities and develop interventions for improvement. Identifies deficiencies and recommends corrective action.
Identifies risks impacting HEDIS, CMS Core measures and other performance measures conducting root cause analyses. Facilitates mitigation and resolution plans by working directly with internal departments and subcontracted providers. Collaborates with internal and external stakeholders to research, analyze, and execute opportunities related to HEDIS, CMS Core measures and other quality measures.
Leads or participates in the annual AHCCCS Operations Review and annual contracted health plan Operations Review. Attends Quarterly Health Plan Meetings as needed. Provides technical assistance regarding contractual and policy requirements. Accurately and consistently improves compliance with AHCCCS requirements and impro