H20 Quality Management Specialist

Solari•Tempe, AZ

6d•$51,000 - $59,500•Hybrid

About The Position

The H2O Quality Management Specialist supports day-to-day quality monitoring, compliance, and performance activities for Solari’s administration of the AHCCCS Housing and Health Opportunities (H2O) program. The role reviews provider performance, service documentation, data quality, utilization, billing and service trends, and other quality indicators. It supports audits, corrective actions, reporting, and quality improvement initiatives; collaborates with providers and internal teams to address identified issues; and serves as a resource for routine quality matters while escalating significant trends, risks, and compliance concerns to the H2O Quality Management Administrator. The position also supports provider education and technical assistance, reviews claims and billing patterns, maintains quality management records and tools, and collaborates across internal teams to promote member outcomes, provider performance, compliance, service delivery, and program effectiveness. The role reports to the H2O Quality Management Administrator.

Requirements

At least 2 years of experience in the field.
Bachelor’s degree in Healthcare Administration, Public Administration, Social Work, Business Administration, Public Health, Data Analytics, Human Services, or a related field.
Knowledge of quality assurance, quality monitoring, compliance, auditing, and continuous improvement principles, and healthcare, human services, housing, or publicly funded program operations.
Ability to review documentation and data against established standards, identify discrepancies, trends, and risks, and consistently apply policies, procedures, contractual requirements, and program guidance.
Strong analytical, organizational, problem-solving, and communication skills.
Attention to detail and ability to maintain accurate records, analyze and communicate quality and performance information, manage multiple priorities, meet deadlines, and follow issues through resolution.
Proficiency with Microsoft Office applications and ability to learn and navigate HMIS, Electronic Health Record, claims, and other program systems.
Ability to act professionally and maintain appropriate boundaries with clients and staff.
Ability to report as scheduled to work, meetings, training, and job-related activities prepared and on time.
Ability to demonstrate compassion, effort, and ownership in interactions and work.
Open and accepting mindset, including active learning, participation in discussions, trying new approaches and ideas, and self-awareness and reflection for continued personal, professional, and leadership growth.
Ability to meet the stated home-office internet requirements when working from home: stable and secure private internet with at least 50 Mbps download, 5 Mbps upload, and average jitter below 20% of latency.

Responsibilities

Conduct routine quality monitoring and reviews of H2O provider performance, service delivery, documentation, housing care plans, utilization, and other program requirements.
Apply established monitoring tools, criteria, policies, and procedures to evaluate compliance with AHCCCS, H2O, contractual, and organizational standards.
Document monitoring findings, deficiencies, follow-up requirements, and resolution activities.
Track corrective action plans, remediation activities, and quality improvement commitments through completion.
Support preparation for AHCCCS reviews, audits, and monitoring by gathering documentation, validating records, and tracking follow-up items.
Identify and escalate significant, recurring, or systemic quality and compliance concerns to the H2O Quality Management Administrator.
Review H2O data and documentation for accuracy, completeness, consistency, and timeliness; coordinate correction of missing, inconsistent, or potentially inaccurate information.
Compile and monitor provider performance metrics, service utilization, housing outcomes, and quality indicators.
Prepare routine quality and performance reports, summaries, trackers, and monitoring materials.
Analyze data and results to identify trends, service gaps, recurring issues, and potential quality or compliance risks, and communicate findings to the administrator and appropriate stakeholders.
Communicate routine quality monitoring findings, documentation concerns, and follow-up requirements to providers.
Support identification of provider education and technical assistance needs; assist with developing and delivering training materials on H2O requirements, documentation, billing, housing care planning, and quality measures.
Track provider corrective actions and performance improvement activities and report progress or unresolved concerns.
Serve as a resource for routine provider questions about quality expectations, monitoring processes, documentation requirements, and service delivery standards.
Review claims, billing, reimbursement, and service authorization trends for potential quality, documentation, or compliance concerns.
Research billing and claims discrepancies and coordinate with providers and internal teams to support resolution.
Track recurring claims or billing issues, identify patterns, and escalate systemic or unresolved concerns to the H2O Quality Management Administrator.
Support development and maintenance of guidance, tools, and quality controls to reduce recurring billing and documentation issues.
Maintain quality monitoring records, trackers, audit documentation, corrective action records, and other quality management materials.
Support implementation and maintenance of quality management procedures, workflows, tools, and documentation standards.
Participate in quality meetings, provider reviews, performance discussions, and cross-functional workgroups; prepare meeting materials, quality summaries, findings, and follow-up documentation as assigned.
Collaborate with Quality Management, Provider Support, Operations, Claims, Compliance, Business Analytics, and Evaluation & Impact teams to resolve quality concerns and support program objectives.
Participate in continuous quality improvement initiatives focused on member outcomes, provider performance, compliance, service delivery, and program effectiveness.
Perform other duties as assigned.

Benefits

Generous paid time off (PTO).
Medical, dental, and vision health benefits beginning the first of the month following the hire date.
On-site fitness room free to employees at the Tempe office.
Basic life insurance.
Voluntary life, spouse, and child insurance.
Critical illness coverage with free dependents.
Critical illness coverage for spouse.
Short-term and long-term disability, beginning the first of the month after 90 days of employment.
401(k) and Roth 401(k), beginning the first of the month after 90 days of employment.
United Pet Care.
LifeLock identity theft protection.
LYRA EAP Program with 25 free mental health sessions per family member.
Friendly work environment.
Competitive compensation.
Convenient office locations and hybrid schedule.