Quality Improvement Specialist I - Tucson, AZ (Corporate-Bonita)

Looking to build a lasting career? Join a team that is inclusive and embraces all individuals. Intermountain Centers is one of the largest statewide behavioral health and integrated care organizations in Arizona. What does building a lasting career look like?
• Top-level compensation packages
• Exceptional health, dental, and disability benefits
• Career and compensation advancement programs
• Student loan forgiveness programs
• 401k company match
• Bilingual pay differential
• Holiday, PTO and employer paid life insurance
• Clinical licensure supervision and reimbursement
• Evidence-based treatment approaches, training, and supervision
• One of the first fully vaccinated COVID-19 workplaces in Arizona
Intermountain Centers and its statewide affiliates, Community Partners Integrated Healthcare, Pinal Hispanic Council, Intermountain Health Center, Intermountain Foster Care, Behavioral Consultation Services and MHRI Housing are currently recruiting career-minded individuals interested in opportunities within the largest adult and child service continuum in Arizona.


General Summary: The Quality Improvement Specialist I is responsible for compliance and performance improvement functions within the organization including the collection of data, analysis, and reporting. The Quality Improvement Specialist I may work with regulatory agencies and may assist with submission of deliverables.

JOB RESPONSIBILITIES:
• Create processes for validating clinical documentation to billing and medical necessity. Develop reports as required.
• Work with finance, executive leadership, and sites as appropriate for audits, data requests, and reports.
• Audit and create reports needed for initiatives.
• Work with IS and other related departments to develop systems to access data for measuring adherence to overall compliance, accreditation standards, quality of care.
• Serve as the HIE point of contact for QI.
• Work with IS, Clinical, and other departments to identify what data is needed, and facilitate/oversee activities to ensure data is provided as required.
• Provide sites/staff with data related to member use of emergency room services, hospitalizations, and discharges.
• Work with sites to ensure members are seen 7- and 30-days post hospitalization, and post release from incarceration as applicable.
• Develop process for identifying members with adverse events resulting in hospitalization, ED visit, incarceration and provide reports to teams. Audit high utilizers of these systems and review ISPs, interventions with reports so clinical teams can modify treatment approach, accordingly, assess if SMI determination and/or special assistance needed, etc.
• Participate in health plan and regulatory meetings as applicable and communicate upcoming changes in processes as applicable.
• Work with IS to create reports to identify OOH placements, and relevant information.
• Work with IS, Finance, and other relevant departments to develop reports related to authorizations, concurrent reviews, denials.
• Develop process for tracking and reporting MIA/Navigator and missed appointments for Phoenix, working with IS and other departments as needed.
• Submit deliverables to health plans timely. Respond to inquiries related to deliverables.
• Special Assistance: submit applications, update members’ information in OHR portal, submit a bi-monthly deliverable.
• Performs other duties as assigned or necessary as they relate to the general nature of the position.
QUALIFICATIONS:
• Education – Bachelor’s degree in a field appropriate to the area assignment; OR any equivalent combination of education and/or experience from which comparable knowledge, skills and abilities have been achieved. High School Diploma or GED required.
• Experience - One year of related experience preferred. Experience with analyzing and reporting data outcomes aimed to improve quality of service. Experience with auditing clinical documentation based on quality-of-care standards, identifying improvement opportunities, and providing constructive feedback to improve performance. Knowledge of health plans, insurance, and regulatory requirements preferred.
• Certification – CPHQ or other certification in quality management preferred.
REGULATORY:
• Minimum 21 years of age.
• DPS Level I fingerprint clearance (must possess upon hire and maintain throughout employment).
• CPR, First Aid, AED certification, if required (must possess upon hire and maintain throughout employment).
• Current, valid Arizona Driver’s License and 39-month Motor Vehicle Report and proof of vehicle registration liability insurance to meet insurance requirements, if required.
• Initial current negative TB test result, if required (Emplo