Quality Assurance Specialist I/II (20752441)

$2500 Sign-on Bonus! Hybrid Teleworking Schedule Available. Annual Salary Ranges: Quality Assurance Specialist I $79,255.55 - $101,152.37; Quality Assurance Specialist II $87,483.33 - $111,653.44. The Position We are currently looking for a Quality Assurance Specialist I or II to work within our Best Practices Department. A Quality Assurance Specialist I/II implements program compliance with fraud, waste, and abuse prevention, performing quality assurance audits, training, monitoring, and processes to maintain the Tri-City Mental Health Quality Assurance Program in accordance with specified county, state, and federal laws and regulations, including the Health Insurance Portability and Accountability Act (HIPAA). The role develops systems and standards for best practices for compliance evaluation and reporting; conducts quality assurance audits and training sessions; and performs related duties as assigned. The position reports to a Quality Assurance Supervisor. This position will perform the following essential duties, including, but not limited to: Assists with maintaining the Authority’s quality assurance program in accordance with federal, state, and local laws and regulations, Authority rules, guidelines and values; develops systems and standards for compliance evaluation; implements training, monitoring, and processes to ensure that Authority activities are in compliance with specified laws; conduct strategic analysis, evaluate programs and recommend ways on how to improve and integrate the quality assurance message into all aspects of the Authority’s business and human relations. Evaluate and monitor information related to program operations and quality of care, program design, methodologies, and outcomes; analyzes fraud, waste, abuse, information management and privacy, and other applicable violations; quality assurance and audit results; and policies, strategy, and regulatory materials. Coordinate the development and implementation of reporting processes and systems; conduct risk assessments and analyses; plan and conduct compliance, evaluation, and related training sessions; and use technical and analytical expertise to develop findings, provide consultation, and make recommendations to supervisor and leadership. Monitors and tracks all phases of the audit cycle; selects appropriate records, reviews and inspects client records to ensure compliance and evaluates the quality and effectiveness of services; provides feedback, guidance, and support to clinical programs; documents findings and tracks outcomes; creates audit outcome reports and recommendations on issues relating to the program area; disseminates feedback to appropriate staff in the clinical program, and provides follow‑up with supervisors and managers to ensure completeness. May perform investigations of highly sensitive or complex issues related to quality assurance and clinical programs, diagnosis, clinical quality of care and make recommendations to supervisor and leadership. Compiles, monitors, and reports performance outcomes related to quality assurance and compliance and provides support to clinical department with outcome measures and general support with quality assurance performance measures; serves as contact for clinical programs and services. Assists in determining the type and frequency of training needs; collaborates with the Quality Assurance Supervisor in the design and delivery of training; develops job specific training manuals to be used during staff training for each health center implementation and ongoing support. Coordinates with the Quality Assurance Supervisor in the implementation of policies and procedures concerning best practices and compliance issues. Assist in development and or lead implementation of priority projects to ensure the agencies compliance with quality assurance. Reviews charts in the Electronic Health Records (EHR) system to monitor clinical staff records and to ensure compliance; trains staff and interns on documentation standards, new processes and on the chart review process. Assists with the facilitation of all internal and external quality assurance audits; assists program staff in preparing for audits; assists with collaborating on the implementation of any corrective action as a result of the audit. Provides consultation to and responds to inquiries, requests, and/or complaints related to quality of care and quality assurance. Participates in any training needed, and may serve as a liaison for agency, county, state meeting, committee, and compliance groups on monthly or quarterly basis; facilitates quality assurance meetings, workshops, and committees in order to enhance documentation quality within the agency. Creates and maintains internal quality assurance bulletin and or notices and provides this information to clinical program leadership and staff on an as needed basis; maintains and archives external quality assurance bulletins and documents through tracking system. Maintains records to ensure that staff and providers have appropriate licensure, credentials, education, training, and other required certification. Stays abreast of new trends and innovations in behavioral health, prevention and early intervention, curriculum development, training, and other areas of assignment. Keeps abreast of all federal, state, county and Authority compliance policies and procedures and all regulations pertaining to quality assurance and documentation; researches and analyzes protocols, best practices, policy issues, pending legislations and regulations and makes recommendations to Supervisor regarding impact on agency and services; disseminates knowledge to clinical department and ensure compliance on a continuous basis. Facilitates, maintains, monitors, compiles compliance results, and follows through with site Medi-Cal certification requirements under county, state, and federal regulations. Observes and complies with all Authority and mandated safety rules, regulations, and protocols. Performs related duties as required. Qualifications Any combination of education, training, and experience that provides the required knowledge, skills, and abilities to perform the essential duties of the position is qualifying. The incumbent will possess the most desirable combination of education, training, skills, and experience, as demonstrated in their past and current employment history. Education: Equivalent to a bachelor’s degree with major coursework in behavioral health, social work, or a related field. Experience: Quality Assurance Specialist I: Two (2) years of experience in compliance or quality assurance in a behavioral health or social services setting. Quality Assurance Specialist II: Four (4) years of increasingly responsible experience working in quality assurance in a behavioral health or social services setting. Substitution for required Quality Assurance experience may be made as follows. Clinical Experience Substitution: One (1) year of clinical experience is equivalent to six (6) months of quality assurance experience. A maximum of four (4) years of clinical experience may be substituted, which is equivalent to two (2) years of quality assurance experience. Advanced Degree / Registered Nurse Substitution: A Master’s degree, Ph.D., or Registered Nurse (RN) credential with coursework in behavioral health, social work, or a related field is equivalent to one (1) year of quality assurance experience, maximum. California Licensure Substitution: Possession of a California license as a Marriage and Family Therapist (MFT), Licensed Clinical Social Worker (LCSW), Professional Clinical Counselor (PCC), Clinical Psychologist, or Psychiatric Registered Nurse is equivalent to two (2) years of Quality Assurance experience, maximum. #J-18808-Ljbffr Tri-City Mental Health Authority