Quality & Compliance Manager - Outpatient Services

Job Title

Quality Assurance Auditor/Program Evaluation Work Lead, Change Management and Data Analyst, Work Lead Quality and Compliance Training

Job Description

Weekly hybrid working arrangements with minimum 2 days in the office and maximum 3 days of remote work. This position will comply with the Civil and Forensic Mental Health - Outpatient Services current working arrangements. Please note: Work arrangements are subject to change at any time.

What You'll be doing:

• Forms, leads, and maintains the OSDV Credentialing Committee, in alignment with NCQA standards, and leads program directors to support these efforts.
• Oversees the work of payer enrollment for all of OSDV, ensuring staff compliance.
• Leads quality and compliance audits, evaluation, and analysis to OSDV.
• Presents data and relevant findings to OSDV and CFH leadership, as well as internal or external stakeholders, as directed by the Division Director.
• Uses audits and program evaluations to lead clinical quality and continuous quality improvement of services provided to the Division's clients and supports decision-making with relevant results and analyses that influence positive outcomes.
• Partners with leadership to identify benchmarks for their programs to maximize effectiveness with the clients served.
• Audits programs to these benchmarks and division-wide standards and provides feedback to leadership regarding problem areas in operating procedures and standards across various locations and settings.
• Reviews and evaluates organizational policies, practices, structure, functions, programs, work methods, resources, and program performance and formulates solutions to increase the efficiency and effectiveness of Forensic Services.
• Performs internal case audit and analysis for compliance with Consent Decree requirements, department benchmarks, and department standards and protocols.
• Has experience working with the SMI population, and is knowledgeable about research-based SMI treatments, evidence-based effective principles for intervention, and quality auditing practices.
• Performs internal review to align operations and practice with BHA rule, statute, and Federal law, as applicable.
• References and regards professional ethical codes and board rules governing the practice of the Outpatient Clinic treatments, and brings findings, both positive and negative, to leadership to influence practice, quality, and compliance.
• Work lead for 20 FTE; guiding, coaching and mentoring subordinate staff.
• Provides input into performance plans and evaluations and works in collaboration with the supervisor.
• Leads and identifies areas for improvement; identifies the issues related to process improvement; and be successful in communications and recommendations for change by reviewing program documents, policy updates, and conducting chart audits.
• Works closely with teams, individuals, and leaders within Outpatient Services to successfully affect change management and process improvement with current practices. If additional data or statistical analysis is needed this position works with the information management team to ensure data is presented timely.
• Operates independently in performing professional tasks. This includes performing complex, cross-functional, division-wide projects or initiatives to improve processes or outcomes.
• Tracks performance against established goals and makes associated recommendations to maximize performance. New processes or objectives are reviewed with leadership.
• Responsibilities include working with staff and leaders, evaluating and providing suggestions to processes and must possess the ability to lead without direct authority over others.
• Responsible for the ongoing efforts of the quality of processes and programs.
• Collaborates and uses skills to communicate process change with staff.
• Required to use diplomacy and professionalism while working with internal stakeholders representing Outpatient Services.
• Collaborates with leadership to develop their program and process auditing and compliance tracking system to assure that Outpatient Services is complying with federal regulations, state statutes, policies and standards and Consent Decree, and Statutory requirements.
• Analyzes and monitors the effectiveness of problematic approaches and identifies avenues to improve practices.
• Program analysis is identifying deficiencies or barriers and reaching a conclusion to be presented to leaders.
• In collaboration with leaders, provide formal feedback and consultation to staff in reflection of all audits and work reviews.
• They may be required to participate in committees or work groups to provide program guidance and clarification, and provide input on issues that have a direct impact on the program.
• Leads and has a unique level of expertise in the quality, rules, and regulations that is critical for the success of the division. Leaders and staff recognize and seek the technical guidance and direction from this position.
• Leads and assists in the facilitation and training across Outpatient Services for continuous quality improvement initiatives.
• Facilitates and leads continuous improvement efforts (workshops, training, and coaching) using methods for data gathering and analysis, problem solving, project management and professional presentation skills.
• Determines and implements training within Forensic Services to deliver specific training and technical assistance.
• Develops instructional guidance to provide direction on consistent implementation to intra-agency departments within Forensic Services.
• Has the ability to interpret and communicate results to all audiences.
• Communicates and teaches process improvement methods, tools, techniques, and best practices to staff within Forensic Services and develops communication and training materials in alignment with department strategies or policies.
• Creates and presents process improvement techniques and improvement results to various audiences.
• Is the work lead for 20 FTE; guiding, coaching and mentoring subordinate staff.
• Provides input into performance plans and evaluations and works in collaboration with the supervisor.
• Other duties as assigned.

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights

Experience Only: Seven (7) years of experience in behavioral/mental health clinical work or leadership, healthcare quality, or a similar field.

OR

Education and Experience: A combination of education in behavioral health, healthcare administration, quality management or related field and/or experience in behavioral/mental health clinical work or leadership, healthcare quality, or a similar field equal to seven (7) years.

Preferred Qualifications:

• Knowledge of 27-65 statute, behavioral health regulations, and/or billing and claims law and rule.
• Knowledge of and experience with HIPAA and 42 CFR part 2.
• Previous experience with or detailed knowledge of NCQA credentialing standards.
• Previous experience with and knowledge of BHA rules.
• Previous experience with and knowledge of clinical chart audits and documentation requirements.
• Previous experience with critical incident reporting.
• Relevant years of State service.

Conditions of Employment:

• Full background check and reference check required.
• This position requires State of Colorado residency at the time of application (unless otherwise identified in the posting), and residency within the state throughout the duration of employment in this position.
• Comply with all vaccination requirements that are required by CDHS; TB testing must be completed.
• Former State employees who were disciplinarily terminated or resigned in lieu of termination must:
1. Disclose that information on the application.
2. Explain why the prior termination or resignation should not disqualify you from the current position.
3. Provide your employee number from your prior State employment. Absent extraordinary circumstances, prior disciplinary termination or resignation in lieu of termination and failure to provide this information will disqualify the applicant from future State employment with CDHS.

Supplemental Information

• How to apply to the State of Colorado (Youtube Video, Runtime 3:59, Closed Captions Available)
• The Assessment Process

About Us & Benefits

If your goal is to build a career that makes a difference, join the dedicated people of the Colorado Department of Human Services (CDHS). Our professionals strive to design and deliver high quality human and health services that improve the safety, independence, and well-being of the people of Colorado. Each of us is committed to contributing to a safe and accessible CDHS. In addition to a great location and rewarding and meaningful work, we offer:

• Strong, secure, yet flexible retirement benefits including a PERA Defined Benefit Plan or PERA Defined Contribution Plan plus 401(k) and 457 plans
• Medical and dental health plans
• Employer supplemented Health Savings Account
• Paid life insurance
• Short- and