H20 Quality Management Administrator

The Job/What You'll Do:

The H2O Quality Management (QM) Administrator leads quality management and compliance oversight for Solari's administration of the AHCCCS Housing and Health Opportunities (H2O) program. This position oversees provider quality, performance monitoring, data integrity, utilization, service and billing audits, corrective actions, and performance reporting to promote regulatory compliance, program integrity, and positive member outcomes.

The H2O QM Administrator serves as the primary operational liaison for H2O quality matters with AHCCCS, Banner Compliance, housing service providers, and internal stakeholders. This position supervises QM staff, establishes quality monitoring processes and accountability measures, and partners across Provider Support, Operations, Claims, Compliance, and Evaluation & Impact to identify risk, improve performance, and strengthen service delivery.

Responsibilities:

• H2O Quality Management & Compliance Leadership

  · Lead and administer the H2O Quality Management Program in accordance with AHCCCS policies, H2O program requirements, contractual obligations, and organizational standards.

  · Serve as the primary point of contact for AHCCCS, the H2O provider network, and Banner Compliance regarding quality management, compliance concerns, audits, monitoring activities, and corrective action plans.

  · Establish and oversee monitoring and quality assurance processes for provider performance, service delivery, documentation, utilization, and program compliance.

  · Analyze quality and compliance findings to identify trends, performance gaps, risks, and opportunities for improvement.

  · Coordinate corrective action and quality improvement initiatives with providers, internal teams, and external compliance partners.

  · Lead organizational readiness and follow-up activities for AHCCCS reviews, audits, and quality monitoring activities.

   

  Department SDOH

  Division CSN

  Reports To Director, Housing Eligibility

  Directly Supervises 1; H2O – Quality Management Administrator

  FLSA Status Exempt

  Content Revision Date Click or tap to enter a date.

  Data Quality, Reporting & Performance Monitoring

  · Oversee H2O data quality processes to promote accurate, complete, and timely documentation and reporting.

  · Monitor and analyze provider performance metrics, service utilization, housing outcomes, and quality indicators.

  · Develop, validate, analyze, and present reports related to H2O enrollment, housing stability, service delivery, utilization, and provider performance.

  · Partner with Quality Management Specialists, Business Analysts, the Evaluation & Impact Manager, and operational teams to identify trends, service gaps, operational risks, and improvement opportunities.

  · Ensure quality monitoring and reporting practices align with AHCCCS performance expectations and contractual requirements.

  Provider Quality & Training Oversight

  · Oversee provider quality monitoring and identify trends requiring education, technical assistance, or performance improvement.

  · Collaborate with Provider Support to identify training needs and coordinate education related to H2O requirements, documentation standards, billing expectations, housing care planning, and quality measures.

  · Oversee provider corrective action plans and performance improvement activities, including monitoring progress and evaluating resolution of identified concerns.

  · Serve as an escalation resource for provider quality, compliance, and service delivery concerns.

  Claims & Billing Support

  · Coordinate quality oversight of H2O claims, billing, reimbursement, and service authorization issues that may affect provider performance, compliance, or member service delivery.

  · Partners with providers, Banner, Claims, and internal teams to investigate and resolve systemic billing or claims-related concerns.

  · Analyze claims and billing trends to identify recurring issues, compliance risks, and opportunities for process improvement.

  · Develop guidance, workflows, and quality controls to reduce recurring issues and unnecessary escalations.

  Program Administration & Team Coordination

  · Supervise, coach, and provide directions to Quality Management Specialists and other assigned H2O staff.

  · Establish and maintain quality monitoring procedures, workflows, tools, documentation standards, and accountability measures.

  · Facilitate collaboration among Quality Management, Provider Support, Operations, Claims, Compliance, Business Analytics, and Evaluation & Impact.

  · Lead quality-related meetings, provider reviews, performance discussions, and stakeholder engagement activities.

  · Drive continuous quality improvement initiatives focused on housing stability, member outcomes, provider performance, compliance, and program effectiveness.

  · Other duties as assigned

Knowledge, Skills, Abilities: 

• Advanced knowledge of quality management, quality assurance, compliance monitoring, corrective action, and continuous improvement practices, along with knowledge of AHCCCS requirements, Medicaid or other publicly funded service programs, and applicable regulatory and contractual requirements. Demonstrated understanding of housing and homeless service delivery, including Housing First principles, Permanent Supportive Housing practices, services for individuals with a Serious Mental Illness (SMI) designation, provider performance management, utilization monitoring, claims and billing processes, and performance measurement. Strong analytical skills with the ability to interpret data, identify trends and risks, and translate findings into actionable recommendations. Ability to interpret policies, contractual requirements, and regulatory guidance and translate them into operational processes and quality standards. Strong written and verbal communication skills, with the ability to communicate quality expectations, findings, and recommendations to internal and external stakeholders, lead cross-functional initiatives, manage competing priorities, and maintain effective relationships with providers, regulators, and organizational leaders.
• Ability to act professionally and maintains appropriate boundaries with clients and staff.
• Ability to report as scheduled to work, meetings, training, and job-related activities prepared and as scheduled.
• Ability to consistently demonstrate compassion and meet people with compassion; Effort, every interaction deserves my best effort; and Ownership, which drives the company's success.
• Maintains an open and accepting mindset by being an active learner, participating in discussions with others, trying new approaches and ideas, and being self-aware and self-reflective for continual personal, professional and leadership growth.

Education & Experience:

• 3-5 years of experience in field, Required
• Bachelors Degree in Healthcare Administration, Public Administration, Social Work, Business Administration, Public Health, Data Analytics, Human Services, or related field, Required