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The RBHA Quality Management Administrator oversees quality management, quality improvement and initiatives for the organization in compliance with State and Federal regulations and contractual requirements. Responsible for the development of the QM/UM plan and effective implementation in collaboration with the Chief Medical Officer. Initiates and implements process improvement activities across the organization to ensure high quality outcomes.
Responsible for National Committee for Quality Assurance (NCQA) Accreditation initiatives and Healthcare Effectiveness Data and Information Set (HEDIS) performance.
Ensure compliance with State requirements and with accreditation standards (URAC, NCQA) as reasonable to meet state requirements in all areas of the organization.
ADDITIONAL JOB INFORMATION
The State of Arizona has chosen Mercy Maricopa Integrated Care, a locally owned and operated non-profit health plan, as the new Regional Behavioral Health Authority (RBHA) for Maricopa County.
Mercy Maricopa is sponsored by Mercy Care Plan, an Arizona non-profit with a 28-year history of providing innovative Medicaid managed care administration, and Maricopa Integrated Health System (MIHS), a public health care system caring for the citizens of Maricopa County for 135 years. Both organizations are committed to the community and have experience collaborating with Arizona health care providers who offer high-quality, person-centered health care and deliver holistic, individualized care outcomes.
Mercy Care Plan is sponsored by Dignity Health and Carondelet Health Network, both nationally known mission-driven, faith-based health care systems. Mercy Maricopa selected Aetna Medicaid, as plan administrator, providing comprehensive plan management services.
How to apply
Please use the "Apply" link to apply to this position. If you cannot view this link, you can find this position on our website by visiting: www.aetna.com/working, click on apply online, search openings, and enter 14629BR in the keyword field. Additional information on what it’s like to work for Aetna and more can also be found on our website.
We value leadership, creativity and initiative. If you share those values and a commitment to excellence and innovation, consider a career with Aetna.
We conduct pre-employment drug and background testing.
Aetna does not permit the use of tobacco related products or drugs in the workplace.
Aetna is an Equal Opportunity/Affirmative Action Employer. M/F/D/V
Aetna is committed to maintaining an environment in which all employees are treated equitably and given the opportunity within the context of the business to achieve their potential. Aetna's Affirmative Action responsibilities extend to women, minorities, persons with disabilities and veterans. Company policy also provides for equal opportunity for qualified individuals regardless of race, color, sex, national origin, religion, age, disability, veteran status, sexual orientation, gender identity or marital status.
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REQUIREMENTS: POSITION REQUIREMENTS:
Qualified candidates will possess familiarity working with: State Medicaid regulations; CMS regulations for both Medicaid and Medicare Advantage; NCQA accreditation; HEDIS measures and data; and HIPAA requirements. Prior experience managing/oversight of Quality programs for Medicaid is preferred.
The highest level of education desired for candidates in this position is a Bachelor’s degree or equivalent experience.
LICENSES AND CERTIFICATIONS
The key staff requirement for this position is an Arizona-licensed registered nurse, physician or physician’s assistant or a Certified Professional in Healthcare Quality (CPHQ).
8-10 years of diverse, well-rounded clinical experience
7-10 years of QM experience
4-6 years in management with greater than 5 direct reports
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