Quality Assurance Specialist

Job Description

Job Description

Position Summary

The Quality Assurance Specialist (QA) is responsible for ensuring Pristine Health Services Inc’s compliance with all applicable federal, state, and local regulations including those established by the Maryland Developmental Disabilities Administration (DDA), the Centers for Medicare & Medicaid Services (CMS), COMAR 10.22, and other governing and accrediting bodies while driving continuous quality improvement across operations. This role provides strategic leadership over the agency's Quality Assurance program, overseeing internal audits, compliance monitoring, incident and risk management, and quality improvement initiatives to ensure regulatory compliance, operational excellence, and the safety, dignity, and satisfaction of individuals served.

Key Responsibilities

Regulatory Compliance & Monitoring

• Maintain expert, up-to-date knowledge of DDA regulations (including the COMAR 10.22 series), applicable Medicaid waiver requirements, HIPAA, incident reporting standards, participant rights regulations, and other accreditation/organizational standards.
• Stay current on Maryland DDA policies, guidance, and transmittals.
• Design, implement, and monitor quality assurance systems and processes to ensure adherence to policies, procedures, and service delivery standards.
• Conduct regular compliance reviews of programs such as Residential Services, Meaningful Day/Day Habilitation, Personal Supports, etc.

Internal Audits & Chart Reviews

• Conduct comprehensive operational audits, including site reviews, record reviews, and quality improvement assessments.
• Perform routine and random audits of participant records (PCPs, BSPs, nursing documentation), staff training and credential files, and Medication Administration Records (MARs).
• Identify deficiencies, trends, and areas of risk; produce accurate, timely, and detailed documentation of all QA activities and audit findings.
• Lead the development and execution of corrective action plans (CAPs) and Quality Improvement Plans (QIPs) in collaboration with leadership, and track completion.

Incident & Risk Management

• Lead the Critical Incident Reporting review process to ensure accuracy, transparency, timeliness, and compliance with DDA requirements.
• Ensure proper documentation and follow-up actions are completed.
• Analyze incident data to identify patterns and implement preventative strategies.
• Coordinate and oversee internal investigations, ensuring timely completion and compliance with regulatory standards.

Quality Improvement (QI) Initiatives

• Drive continuous quality improvement (CQI) initiatives to enhance service quality, operational efficiency, and regulatory compliance.
• Collect, track, and analyze quality metrics and outcomes; develop data-driven reports summarizing quality trends, risks, and improvement opportunities for leadership.
• Chair the Quality & Safety Committee, present findings at Quality Assurance Committee meetings, and contribute to cross-functional committees as needed.
• Analyze satisfaction survey data, identify trends, and implement targeted improvement strategies.
• Provide strategic recommendations to leadership to mitigate risk and improve overall program performance.

Policy & Procedure Development

• Assist in developing, updating, and implementing policies and procedures to ensure compliance with DDA and CMS standards and reflect person-centered planning principles and best practices.

Staff Training, Supervision & Technical Assistance

• Deliver training, coaching, and support to staff on documentation standards, compliance requirements, incident reporting, and person-centered practices to promote a culture of quality, compliance, and accountability.
• Support onboarding and ongoing education initiatives.
• Supervise and mentor QA staff, fostering professional development and performance excellence.

External Audit & Accreditation Readiness

• Serve as the primary liaison during external audits, regulatory reviews, inspections, and surveys (including in the absence of the CEO).
• Lead organizational readiness for accreditation and external reviews, ensuring sustained compliance.
• Oversee and maintain all regulatory documentation, ensuring timely submission and compliance with reporting requirements.

Data Management & Reporting

• Maintain QA dashboards and tracking systems.
• Generate reports on compliance, trends, and performance indicators, and utilize data to inform leadership decisions.

Additional Duties

• Perform additional duties as assigned, including travel across service locations.

Key Performance Indicators (KPIs)

• ≥ 95% compliance rate on internal audits
• 100% timely completion of corrective action plans within designated timeframes
• Reduction in repeat deficiencies by a target 20% quarterly
• 100% incident report submission within DDA-required timelines
• Staff training completion rate ≥ 98%
• Audit readiness score (internal mock audits) ≥ 90%

Minimum Qualifications

• Bachelor’s degree in human services, Healthcare Administration, Social Work, or a related field (master’s preferred, or equivalent experience).
• Minimum 2–3 years of experience in quality assurance, compliance, auditing, or performance improvement within a DDA or similar human services/residential setting, including experience working with adults with intellectual and developmental disabilities.
• Strong knowledge of federal, state (including Maryland DDA regulations, COMAR 10.22, and waiver services), and local regulatory requirements.
• Demonstrated experience with audits, investigations, and regulatory compliance.
• Proven ability to work effectively in fast-paced, high-compliance, and confidential environments.
• Excellent written, verbal, interpersonal, and analytical communication skills.
• Valid driver's license with reliable transportation and current insurance.
• Supervisory and case management experience preferred.

Preferred Qualifications

• Certified Professional in Healthcare Quality (CPHQ) or similar certification.
• Experience with electronic health record (EHR) systems.
• Familiarity with behavior support plans and nursing oversight requirements.

Core Competencies

• Attention to detail and accuracy
• Regulatory knowledge and compliance expertise
• Data analysis and critical thinking
• Ethical decision-making and confidentiality
• Communication and training skills
• Problem-solving and continuous improvement mindset
• Leadership and staff development

Working Conditions

• Office and field-based role, with visits to residential and day program sites.
• Requires travel within the state of Maryland.
• Occasional evening or weekend work during audits or investigations.

Physical Requirements

• Ability to travel between program sites.
• Ability to sit, stand, and review documents for extended periods.

Benefits:

• 401(k)
• Paid time off

Work Location: In person