Job Description

Position Purpose:  Under the direction of the Clinical Review Manager, this position is responsible to perform investigations, surveys, and medical record audits of various provider types within SHCA’s region. Supports compliance with contractual requirements, including federal and state medical record documentation requirements and policies. This position collaborates with Quality Management and other organizational staff to monitor, review and evaluate performance for quality, utilization, completeness and accuracy; develops and enforces action plans utilizing the PDSA model; collaborates and provides technical assistance to provider network on medical record standards, policies and performance improvement.

 

Essential Duties and Primary Accountabilities:

 

Responsible for auditing medical records. Performs internal and external provider monitoring functions to ensure compliance with outcome measures, applicable regulations, policies and protocols, and clinical best practices.

 

Provides technical assistance to provider network employees on requirements and strategies to ensure compliance with AHCCCS medical record requirements.

 

Assists in developing audit tools and scoring guidelines, analyzes audits and communicates results and recommendations with internal and external staff and provider agencies.

 

Collaborates with internal departments, provider network agencies, internal and external stakeholders and state agencies in regards to medical record standards.

 

Tracks longitudinal data to identify and respond to trends and/or emerging issues and to ensure compliance with minimum performance standards. Ensures identification and development of performance improvement opportunities and strategies, technical assistance and enforcement activities. Conducts research, reviews, analyzes and compiles data, develops recommendations and reports.

 

Participates in internal and external committees, projects and work groups and participates in or collaborates with SHCA committees, projects, and work teams.

 

Performs other duties of a similar nature and level as assigned.  Some local travel is required.



Qualifications

Education:   

·         Bachelor’s degree in behavioral health

 

Years of Experience:  

·         Two years’ experience related to area of assignment, preferably within the Arizona health system.

 

Work Related Experience:  

·         Proficiency in developing and presenting analytic reports (written and verbal), data collection, sampling, analysis and presentation.

·         Knowledge of the Arizona AHCCCS Medicaid system, behavioral health system and its resources.

·         Knowledge of the principles and benefits of integrated health care and population health, and/or willingness to learn.

·         Ability to work effectively and efficiently both independently and as part of a team.

 

Specialized Knowledge:  

·         Excellent communication and collaboration skills.

·         Ability to document activities accurately and timely in an electronic medical record system.

·         Ability to prioritize and effectively handle multiple projects.

·         Ability to maintain confidentiality, privacy and security of protected health information.

·         Knowledge of Microsoft Office applications; program evaluation and project management; effective communication both verbally and in writing.

·         A valid Arizona drivers’ license.

Application Instructions

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