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The Quality Management Department
The Quality Management (QM) Department identifies opportunities
for the improvement of care and services that can benefit both
our members and providers. The process is accomplished by assisting
with the identification, investigation, implementation, and
evaluation of corrective actions that continuously improve
and measure the quality of clinical and administrative service.
An evaluation of the Quality Management functions is to be
performed annually to ensure that Care 1st Health Plan Arizona, Inc.
is providing high quality health care to the diverse population
in Maricopa County.
Focus Areas
Specific key elements of focus for the Quality Management Department
may include but are not limited to:
• Provider accessibility and availability
• Provider satisfaction
• Provider Credentialing
• Clinical practice guidelines
• Under and over utilization
• Adverse outcomes/sentinel events
• Medical record keeping practices
• Facility site reviews
• Member satisfaction/grievances
• Timeliness of handling claims
• High risk and high volume services
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