Bureau of Medicaid Quality Management

The Bureau of Medicaid Quality Management consists of three offices: 1) Office of Medicaid Research Contracts and Evaluations; 2) Office of Medicaid Program Oversight (formerly the Monitoring Unit); and 3) Office of Project Management. The three units are focused on optimizing and improving quality in our programs, our policies, our implementations of projects and research.

The Office of Medicaid Program Oversight (MPO) is responsible for developing standards and tools for effectively monitoring Medicaid services; developing standards for data exchange and data use agreements; prevent unnecessary and inappropriate utilization of Medicaid services; reduce duplication of Medicaid services; ensure our Florida Medicaid Management Information System (FMMIS) agrees with Medicaid program operations; review program policies to ensure appropriateness of edits in our Florida Medicaid Management Information System; ensure compliance of program operations with policy; compare various alternative managed care models/programs; sample claims and eligibility for analyses of programs and services; run trends for various programs; identify best practices and make recommendations based on findings; conduct random site visits (required by statute); and conduct targeted site visits (based on analyses).

The Office of Medicaid Research Contracts and Evaluations (MRCE) is responsible for connecting Medicaid administrators and policymakers to quality health information through the translation of advanced Medicaid health services research; development and management of quality Medicaid research/evaluation contracts; data extraction, compilation, analysis and interpretation, and modeling; conducting quality Medicaid research activities to support policymaking decisions; linking quality Medicaid research findings to planning options, prepare legislative reports and analyses; maintain current working knowledge of Medicaid and other health policy issues on all levels of government; develop quality Medicaid fact sheets, policy briefs, and reports to inform management/public on Medicaid issues of importance; complete special projects as needed; review, advise and provide technical assistance on Agency for Health Care Administration products with research and policy implications; pursue grant opportunities at all levels; complete ad hoc requests related to the Office of Medicaid Research Contracts and Evaluations office; correspondence on community health resources, alternate care, and health information.

The Office of Project Management (PMO) is responsible for managing and monitoring projects within the Division of Medicaid; establishing a project management methodology including processes, policies, and procedures for project management; providing document templates to aid in project management and the documentation of project activities; performing project initiation, planning, execution, control, and closeout activities; providing a central location to track and report the status of all Medicaid projects; providing mentoring and guidance to project managers, project leads, and project teams; assisting Medicaid staff in attaining knowledge related to project management best practices through activity specific training.

Susan Dilmore, PMP, is the Chief of the Bureau of Medicaid Quality Management.

Administrative Staff Support for the Bureau of Medicaid Quality Management includes
Janice Ruis

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