H20 Quality Management Specialist

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.

• 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 elevate significant, recurring, or systemic quality and compliance concerns to the H2O QM Administrator.

• 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.

• 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.

• 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.
• 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.