POSITION SUMMARY

The Quality Assurance Manager assists with the review, development, and implementation of the organization’s quality programs and plans. This position is accountable for utilizing significant professional judgement and discretion to monitor, review, and respond to quality concerns relating to patient care. Additionally, this position monitors trends, proactively identifying technical and compliance issues/gaps in patient care.

This is an exempt position that reports to the Director of Medical Operations.

Essential Functions

• Develop and implement effective quality management systems (QMS)

o Promote awareness of QMS and applicable regulatory/statutory requirements throughout the organization

o Drive the collection, review, and reporting of data to support quality improvement initiatives and activities including data related to the measurement and improvement of the Healthcare Effectiveness Data and Information Set (HEDIS), URAC, contractual quality metrics and annual Quality Work Plan

o Prepare and implement patient quality programs and related procedures

o Co-Chair Quality Improvement Committee (QIC)

• Facilitate quality complaint process

o Receive complaints from patients, payors, employees, regulatory entities, etc.

o Coordinate with stakeholders and subject matter experts to complete investigation

o Prepare and distribute findings of fact with recommendations for quality improvements/corrective action as appropriate

o Analyze complaint related data to identify systemic issues and concerns

• Risk management

o Utilizes and assesses organizational incident reports and other relevant data to support clinicians and support staff to drive risk mitigation initiatives to reduce harm in healthcare.

o Work cross-departmentally to develop targeted education and process improvement projects using a PDSA model.

• Develop, maintain, and implement aspects of various quality system improvements

o Identify resources and subject matter experts

o Organize projects with a continuous model framework to allow for monitoring of progress or concerns.

o Prepare and maintain documents, reports, dashboards, and scorecards

o Track and trend key performance indicators

Quality Assurance Manager

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are

required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

o Serve as a resource for education and training regarding quality improvement, accreditation standards, internal process improvements, and external regulatory requirements (i.e. HEDIS, CMS, URAC)

• Other duties as assigned

Education and Experience

• HS Diploma or GED (Required); Bachelor’s degree in related field preferred (healthcare administration, business administration, etc.)
• Current unencumbered AZ LPN license
• Ability to obtain / maintain a fingerprint clearance card
• Minimum of 5 years’ related healthcare quality experience (clinical, administrative, quality, health information management)
• Experience with using electronic medical record systems
• Certified Professional in Healthcare Quality (CPHQ) (preferred)
• Experience with Lean Six Sigma practices (preferred)
• Understanding of HEDIS quality measures and successfully demonstrated outcomes
• Familiarity with clinical outcomes, quality improvement methods, utilization management, care management and compliance requirements
• Ability to resolve employee issues and foster inter-departmental cooperation and communication
• Demonstrated leadership skills and the ability to work independently

Tools and Equipment Requirements

• Up to date with advancements in office gadgets and applications (i.e. phone, computer, printer, copier, etc.)
• Frequent use of Microsoft office products, including but not limited to Outlook, Word, Excel, and PowerPoint
• The ability to use the internet and various web browser software is required
• Knowledge of, and ability to use electronic medical record and other patient related technologies

Physical Working Conditions and Office Setting Description

• This position may be remote, hybrid or in-person based on the assigned department’s business needs.

o If designated as hybrid or remote, the availability of virtual workdays is subject to change based on business needs

• Some travel required to field locations to facilitate execution of responsibilities. Must be able to travel to locations other than primary worksite

o Driver’s license and valid insurance may be required when operating a personal vehicle