Manager AR Home Quality

Job Summary

The Manager AR Home (Medicaid) Quality directs programs for all quality measures. The incumbent collaborates with higher level leadership to develop the strategy for appropriate measures and implements programs to support meeting state requirements. The Manager is responsible for keeping the team focused on project documentation and implementation while collaborating with internal teams, vendors, and key state providers to support strategic development, drive program success, enhance analytics, and achieve quality program outcomes.

Requirements

• EDUCATION
  • Bachelor’s Degree in Business or a Medical background.
    • In lieu of degree, five (5) years' experience engaging with physicians and health care providers required in addition to the experience requirements listed below.
• Experience & Knowledge
  • Minimum five (5) years' experience engaging with physicians and health care providers.
    • Minimum two (2) years' experience with government programs quality measure/program experience in Medicare (HEDIS, CMS Quality measures).
    • Minimum Two (2) Years' Experience Related To Regulatory Requirements.
    • Minimum two (2) years' leadership experience (role, project management, team leader, etc.).
• Experience working with Microsoft Office (Excel, Access, etc.).
  • Experience working with healthcare claims data.
• Knowledge of Medicaid/Government Programs preferred.
  • Knowledge of Arkansas clinical quality, physician, and pharmacy landscape preferred.

Skills

• Activity Coordination
  • Analyze Information
    • Coaching Others
      • Continuous Learning
        • Cross-Functional Communications
          • Evaluating Information
            • Interpersonal Communication
              • Interpersonal Relationships
                • Management Techniques
                  • Monitor Processes, Materials, or Surroundings
                    • Object Identification
                      • Organizing Public Relations (PR) Management
                        • Service Oriented Responsibilities
                          • Collaborates with other internal departments as necessary.
                            • Collaborates with team to prepare reporting and documentation for updates to state Medicaid department and other team members.
                              • Completes intervention outreach to members, as needed, for specified Medicaid measures or escalated cases from Clinical Outreach team.
                                • Develops, implements, and manages performance improvement of Medicaid quality program while identifying and articulating results, barriers, and opportunities.
                                  • Drives the strategic direction and development of outreach programs at both the portfolio and initiative levels, ensuring compliance with Medicaid quality standards while improving outcomes across preventive screenings, medication management, behavioral health interventions, and appropriate clinical follow-up.
                                    • Manages budgets and staffing for interventions in collaboration.
                                      • Manages hiring, coaching, training, employee development, and performance management of team.
                                        • Promotes partnerships with Healthcare Effectiveness Data and Information Set (HEDIS) Director and Education Manager to develop collaborative programs for clinical measure to educate providers and abstract medical records.
                                          • Provides clinical guidance, support and oversight to the assigned Medicaid teams.
                                            • Works with vendors and cross disciplinary teams to coordinate activities and oversees the collection, analysis, reporting and trending of data relative to Medicaid performance, outcomes and return on investment of intervention activities.
                                              • Performs other duties as assigned.