H20 Quality Management Specialist

The Job/What You’ll Do:

The H2O Quality Management (QM) Specialist supports day-to-day quality monitoring, compliance, and performance activities for Solari’s administration of the AHCCCS Housing and Health Opportunities (H2O) program. This position reviews provider performance, service documentation, data quality, utilization, billing and service trends, and other quality indicators; 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 QM Administrator.

Responsibilities:

• H2O Quality Management & Compliance

  · Conduct routine quality monitoring and reviews of H2O provider performance, service delivery, documentation, housing care plans, utilization, and other program requirements.

  · Apply established quality monitoring tools, criteria, policies, and procedures to evaluate compliance with AHCCCS, H2O, contractual, and organizational standards.

  · Document monitoring findings, identified deficiencies, required follow-up, and resolution activities.

  · Track corrective action plans, remediation activities, and quality improvement commitments through completion.

  · Support preparation for AHCCCS reviews, audits, and monitoring activities by gathering documentation, validating records, and tracking follow-up items.

  · Identify and escalate significant, recurring, or systemic quality and compliance concerns to the H2O QM Administrator.

  Data Quality, Reporting & Performance Monitoring

  · Review H2O data and documentation for accuracy, completeness, consistency, and timeliness.

  · Identify missing, inconsistent, or potentially inaccurate information and coordinate with appropriate teams or providers to support correction.

  Department SDOH

  Division CSN

  Reports To H2o Quality Management Administrator

  Directly Supervises N/A

  FLSA Status Exempt

  Content Revision Date Click or tap to enter a date.

  · Compile and monitor provider performance metrics, service utilization, housing outcomes, and quality indicators.

  · Prepare routine quality and performance reports, summaries, trackers, and other monitoring materials.

  · Analyze data and monitor results to identify trends, service gaps, recurring issues, and potential quality or compliance risks.

  · Communicate findings and observations to the H2O QM Administrator and appropriate internal stakeholders.

  Provider Quality & Training Support

  · Communicate routine quality monitoring findings, documentation concerns, and follow-up requirements to providers.

  · Support Provider Support and the H2O QM Administrator in identifying provider education and technical assistance needs.

  · Assist with development and delivery of training materials related to H2O requirements, documentation standards, billing expectations, 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 related to quality expectations, monitoring processes, documentation requirements, and service delivery standards.

  Claims & Billing Support

  · Review claims, billing, reimbursement, and service authorization trends for potential quality, documentation, or compliance concerns.

  · Research billing and claims-related discrepancies and coordinate with providers and internal teams to support resolution.

  · Track recurring claims or billing issues and identify patterns that may affect provider performance, compliance, or member service delivery.

  · Escalate systemic or unresolved claims and billing concerns to the H2O QM Administrator.

  · Support development and maintenance of guidance, tools, and quality controls intended to reduce recurring billing and documentation issues.

  Program Administration & Team Coordination

  · 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.

  · Other duties as assigned.

Knowledge, Skills, Abilities:

• Knowledge of quality assurance, quality monitoring, compliance, auditing, and continuous improvement principles, along with healthcare, human services, housing, or publicly funded program operations. Ability to review documentation and data against established standards, identify discrepancies, trends, and areas of risk, and consistently apply policies, procedures, contractual requirements, and program guidance. Strong analytical, organizational, problem-solving, and communication skills, with attention to detail and the 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 the ability to learn and navigate HMIS, Electronic Health Record, claims, and other program systems.
• 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:

• 2 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