Senior Manager Quality

Banner Health•Goodyear, AZ

21h•Hybrid

About The Position

The Senior Manager, Quality of Care is responsible for leading and overseeing the health plan’s Quality of Care program. In this role, you will manage clinical case reviews, peer review processes, and quality-of-care investigations related to member complaints, adverse events, and potential sentinel events. You will ensure compliance with Medicaid, CMS, state, and accreditation requirements, while directing root cause analyses and driving sustainable corrective and preventive actions. You will partner with Medical Directors, Compliance, Provider Relations, and Operations to implement provider quality interventions and resolve systemic care issues. Additionally, you will develop, optimize, and standardize operational workflows and policies to ensure audit readiness and timely resolution. This role also involves analyzing quality trends to identify risks and opportunities for improvement, as well as leading, coaching, and developing staff. Finally, you will drive continuous process improvement initiatives to strengthen quality outcomes, regulatory performance, and member safety. POSITION SUMMARY This position provides managerial support to Quality Management team and assists in providing effective operations and improvement of quality management services, including hospital-wide performance improvement, regulatory compliance, individual case analysis and follow-up including sentinel events, and decision support. All work processed by the incumbent is considered confidential and protected from discovery, pursuant to state statutes.

Requirements

Active Arizona Registered Nurse License.
Hybrid, Arizona residency is required.
Completion of a Bachelor's degree in appropriate healthcare-related field or the equivalent training and experience.
Working knowledge of hospital operations, medical/nursing staff procedures, hospital and community resources (for Hospital Operations positions).
Working knowledge of Quality Management processes including audits and performance improvement plans and root analysis (for Medicaid or Insurance Division positions).
Excellent leadership skills.
Ability to interact well across departments, facilities, and organizations.
Excellent organizational, human relations and communication skills.
Working knowledge of the medical staff organization, risk management, regulatory programs, and data management and analysis.

Nice To Haves

Master’s degree
Certified Professional in Healthcare Quality (CPHQ) certification
Additional related education and/or experience

Responsibilities

Manage clinical case reviews, peer review processes, and quality-of-care investigations related to member complaints, adverse events, and potential sentinel events.
Ensure compliance with Medicaid, CMS, state, and accreditation requirements.
Direct root cause analyses and drive sustainable corrective and preventive actions.
Partner with Medical Directors, Compliance, Provider Relations, and Operations to implement provider quality interventions and resolve systemic care issues.
Develop, optimize, and standardize operational workflows and policies to ensure audit readiness and timely resolution.
Analyze quality trends to identify risks and opportunities for improvement.
Lead, coach, and develop staff.
Drive continuous process improvement initiatives to strengthen quality outcomes, regulatory performance, and member safety.
Assists in assuring the provision of accurate and reliable data acquisition and analysis to support clinical and administrative decision-making.
Manages significant clinical event process, including identification, investigation, and coordination of root cause analysis, process improvement, tracking, and reporting.
Assists in the coordination of activities to assure compliance with accreditation and regulatory requirements (e.g. JCAHO, DHS, HCFA).
Participates in the hiring, training and conducting of performance evaluations and directs the workflow for the department staff.
Provides leadership assistance to Quality Management staff to achieve optimal clinical, operational, patient safety, financial and satisfaction outcomes.
Serves as a primary resource to staff and administration in the absence of the director.
Participates in the development of the department budget in conjunction with established goals and objectives.
Plays a key role in ensuring budgetary goals are met on an annual basis.
Participates in the development and implementation of Quality Mgmt Services goals and objectives and process improvements.
Ensures all goals and objectives are met timely and effectively.