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Manager of Managed Care Program

Company:
vTech Solution Inc
Location:
Phoenix, Arizona, United States
Posted:
December 05, 2018

Description:

Job title: Manager of Managed Care Program

Location: Phoenix, Arizona

Duration: 6+ Months (Contract to Hire)

Interview: In-Person only

Compliance Requirements:

Employee shall have a valid Level One fingerprint clearance card issued pursuant to Arizona Revised Statute 41-2758.07 in order to work with children and vulnerable adults and shall be subject to a search of the Child Protective Services Central Registry pursuant to A.R.S. 8-804.

Certified Professional in Healthcare Quality (CPHQ) by the National Association for Health Care Quality (NAHQ) or Certified in Health Care Quality and Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers, or comparable education and experience in health plan data and outcomes measurement.

In-state travel may be required. This position requires possession of and ability to retain a current, valid state-issued driver’s license appropriate to the assignment. Employees who drive on state business are subject to driver’s license record checks, must maintain acceptable driving records and must complete any required driver training (see Arizona Administrative Code R2-10-207.12.). 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.

As a Managed Care Organization for the Arizona Health Care Cost Containment System (AHCCCS) for the Arizona Long Term Care (ALTCS) population and 42 C.F., the Division is required by contract to have a robust Quality Improvement program with staff who have the qualifications to carry out the functions and responsibilities specified in the AHCCCS policy and procedures and contract in order to ensure optimized health outcomes and quality of healthcare experiences for members.

The position is critical to the Division as it oversees and directs the Division's quality improvement program. The position will be responsible for ensuring that the Division participates in active and continuous performance improvement initiatives The position will be responsible for contractually mandated Performance Measures, Performance Improvement Projects, and other activities of quality and performance improvement. The position is responsible for data analysis to identify opportunities for improvement, demographic disparities, and assessment of effectiveness and sustained improvement. This position, under the direct supervision of the Chief Quality Officer, serves as the coordinator and project manager for all performance improvement initiatives identified by the unit. The position will also assist in the development and implementation of the AHCCCS mandated Quality Management/Performance Improvement Plan. This position serves as a Key Contact for AHCCCS in regards to Quality Improvement. Furthermore, the position will require coordination with numerous Division and District staff to implement and monitor performance improvement initiatives.

Knowledge/Skills/Ability:

• Comprehensive knowledge of quality and process improvement principles and practices and methodologies, including the PDSA cycle

• Comprehensive knowledge of DDD Policy and Procedures, Administrative Directives, and the service delivery system

• Knowledge of DDD Mission and Value statements, local, state, and federal laws, and other related governing documentation surrounding DDD practices

• Knowledge of human dynamics and organizational systems

• Knowledge of applicable laws, rules, policies, procedures and contract for Arizona Health Care Cost Containment System (AHCCCS)

• Knowledge of the Centers for Medicare and Medicaid Services (CMS)

• Extensive background and knowledge of quality/performance improvement principles (HEDIS, CMS Core Measures, NCQA)

• Effective oral and written communication skills

• Analyze problems and develop effective plans for corrective action

• Continuous improvement and financial accountability

• Word processing, spreadsheet and database applications

• Management and leadership techniques

• Conflict resolution

• Assess, review, and/or analyze situations and/or data, i.e. critical thinking skills

• Project management to meet goals and deadlines

• Strong interpersonal skills

• Evaluate data and documents

• Relate with multi-level of employees and organizational personnel

• Plan and organize complex work and complete reports based on data, and document in a clear and professional manner

• Ability to lead and direct assigned employees

• Clear and concise communication

• Work cooperatively with others, establish and maintain relationships

• Analyze situations accurately and take effective action

• Write reports and policies for program improvement

• Ability to conduct and coordinate trainings on identified issues and procedures

• Maintain comprehensive and confidential information/documentation

• Develop, implement and review quality improvement systems

• Work independently and multi-task in a fast-paced environment

Preferences:

• At least one (1) year experience working in a managed care environment.

• At least two (2) years of experience working with Intellectual Disability population.

• At least two (2) years work experience in a performance improvement role.