Quality Assurance Case Review Specialist

Description

COOK INLET TRIBAL COUNCIL, INC.

Job Title: Quality Assurance Case Review Specialist Department: Financial Assistance Reports To: Quality Assurance and Training Manager Supervises: None FLSA Status: Non-Exempt Pay Grade: N5 Job Type: Regular, Full-Time AKBCU: No ICPA: Yes

General Functions:

The Quality Assurance Case Review Specialist ensures data integrity and service quality across financial assistance programs by conducting comprehensive case file reviews and analyzing program compliance. This position plays a critical role in maintaining CITC's high standards by evaluating the timeliness and accuracy of eligibility determination and case management processes. Working in partnership with our people, the specialist develops opportunities that fulfill our endless potential through continuous quality improvement, trend analysis, and staff training. The role directly supports CITC's mission by ensuring that financial assistance services meet regulatory requirements and organizational values while providing exceptional support to Alaska Native and American Indian participants.

Duties and Responsibilities:

• Conduct comprehensive eligibility and case management quality assurance case file reviews to ensure compliance with established standards, protocols, and CARF requirements.
• Monitor data integrity and accuracy within financial assistance databases to ensure alignment with CITC, CARF, and funding performance requirements.
• Analyze case documentation to identify discrepancies, document trends, and provide recommendations for process improvement and error mitigation.
• Develop and implement training on regulations, policies, procedures, and best practices for financial assistance staff.
• Support Senior Director and Program Managers with development of monthly, quarterly, and bi-annual grant reports and performance metrics.
• Collaborate with cross-functional teams to address quality issues, implement corrective actions, and enhance overall program effectiveness.
• Maintain comprehensive documentation of quality assurance processes, findings, and improvement initiatives.
• Generate regular reports on quality assurance metrics and present findings to management and at Continuous Quality Management meetings.
• Update and maintain 477 enrollment/eligibility databases, intake forms, orientation packets, and workshop schedules as needed.
• Support eligibility and case management staff by providing recommendations to direct management regarding case actions and improvement areas.
• Participate in development and improvement of quality assurance policies and procedures to enhance efficiency and effectiveness.
• Communicate findings to relevant stakeholders through meetings, quarterly and bi-annual staff training sessions.
• Partner with other departments to identify opportunities for process improvement and program enhancement.
• Become proficient with regulations, policies, and procedures associated with financial assistance programs.
• Reviews and investigates appeals and complaints referred by the Participant Engagement Coordinator, and delivers timely feedback and decisions to ensure prompt resolution.
• Identifies and reports to the Quality Assurance and Training Manager appeals trends, and collaborates with staff to develop mitigation strategies for recurring issues and errors.
• Develops monthly and quarterly trend analysis reports for Continuous Quality Management (CQM) review.
• Perform all related duties as needed and assigned.

Job Specifications:

• Strong analytical skills with exceptional attention to detail.
• Excellent verbal and written communication skills.
• Demonstrated ability to systematically review and evaluate cases to maintain and enhance overall quality.
• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
• Strong problem-solving skills with ability to compute ratios and interpret graphs.
• Demonstrated ability to coordinate multiple activities and work as an active participant in a team environment.
• Strong computer skills and group/team facilitation abilities.
• Ability to maintain positive working relationships with CITC staff and external stakeholders.
• Demonstrated knowledge and understanding of the social, health, educational, training, and cultural needs of the Alaska Native and American Indian community.
• Ability to maintain confidentiality following all applicable rules governing confidentiality, HIPAA, and CFR 42.

Minimum Core Competencies:

CITC Values, Respectful Leadership, Professionalism, Emotional Intelligence, Problem Solving/Critical Thinking, Communication Skills.

Minimum Qualifications:

• Continued employment is contingent upon completion of satisfactory state and federal fingerprint criminal background check.
• Bachelor's degree in Business Management or related field. Relevant work experience may substitute for education requirement on a year-for-year basis.
• Two (2) years of program management and/or program monitoring experience.

Preferred Qualifications:

• Experience with program management, writing quarterly reports, and administering funds.
• Experience working with Alaska Native people, knowledge of their values and belief systems, and ability to provide culturally competent services.

Physical Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

• May require prolonged periods of sitting at a desk and consistently working on a computer with repetitive motion.
• The need to occasionally move around the office to access filing cabinets, storage cabinets, and office equipment may be necessary.
• Must be able to lift up to 25 pounds occasionally by utilizing proper lifting techniques and working in a safe manner.

Disclaimer
The information provided in this description has been designed to indicate the general nature and level of work performed by incumbents within this job. It is not designed to be interpreted as a comprehensive inventory of all duties, responsibilities, qualifications and working conditions required of employees assigned to this job. Management has sole discretion to add or modify duties of the job and to designate other functions as essential at any time. This job description is not an employment agreement or contract.