Quality Management Analyst
Under limited supervision, evaluates and recommends improvements for the quality of behavioral health services provided by CODAC and its subcontracted service providers. This position also oversees all on-going activities related to the development, implementation, maintenance of, and adherence to the agency’s policies and procedures, covering the privacy of, and access to, patient health information in compliance with federal and state laws and healthcare organizations’ information privacy practices and utilizing in-depth knowledge of quality management practices.
Essential Duties and Responsibilities:
- Monitors and evaluates the overall quality of integrated health services provided by CODAC and its subcontracted service providers to ensure compliance with regulatory and accreditation requirements.
- Performs periodic chart reviews, data validation reviews, quality improvement monitors and focus reviews and prepares reports of findings and recommendations for corrective action implementation.
- Investigates critical incidents, internal complaints, formal grievances and appeals and prepares reports/responses of findings.
- Monitors and facilitates the responses for Grievances and Appeals.
- Provides training and technical assistance to agency staff and subcontracted providers.
- Serves as QM liaison to departments, committees and work groups within CODAC.
- Monitors agency sites for compliance with regulatory requirements including but not limited to: AHCCCS, CARF, Licensure, DEA and reports results to applicable sites and internal committees.
- Assists with agency-wide preparation process in maintaining national accreditation status.
- Coordination and/or processing of correspondence to other agencies, staff and clients in accordance with policies and procedures related to confidentiality.
- Perform and report on assigned record reviews.
- Assist in annual process of writing, reviewing and updating policies and procedures.
- Performs other duties as assigned in keeping with growth and general responsibilities of the position.
Skills / Requirements
Position Requirements: Pre-employment Competencies/requirements
Education and/or Experience: A combination of one of the following education and work experience are required:
- Masters or Bachelor’s degree in related field and 2 years’ experience in integrated case management or quality management.
- (CPC) Certified Professional Coder-required or the ability to obtain within 12 months
- Valid Arizona Driver’s license, proof of current insurance and willingness to use personal vehicle.
- Motor Vehicle Record - no more than 2 moving violations or a license suspension in past 3 years.
- Extensive knowledge of Systems of Care.
- Extensive knowledge of community resources.
- Extensive knowledge of integrated health challenges which include knowledge of the impacts of mental illness, domestic violence, and the dynamics of addictive behavior.
- Intermediate to advanced computer skills using MS Office products, Word, Excel, Access, etc., importing/exporting data to/from applications.
- Knowledge of basic statistical methodologies.
- Ability to interact effectively with other service providers
- Ability to communicate effectively both orally and in writing