Quality Assurance Manager

Base Pay $80,080.00 per year Employee Type Full Time Exempt Quality Assurance Manager This is a full-time (40 hours), exempt, hybrid position, located at our Vicente campus in San Francisco. Position Summary The Quality Assurance Manager will provide leadership and oversight over quality assurance and quality improvement responsibilities, initiatives, and tasks throughout the organization. Essential Functions Compliance Supports maintaining compliance for all licensing, credentialing, certification bodies (HIPAA, The Joint Commission, DHCS (Department of Healthcare Services), SFDPH/CBHA (San Francisco Department of Public Health), DSS/CCL (Department of Social Services/Community Care Licensing), Private insurance, out of county, etc.) in collaboration with the Associate Director of Quality Management and Regional and Program Managers and Directors. Compliance requirements include but are not limited to contract compliance, outcome evaluation, clinical documentation, EHR Compliance, data integrity, required incident reporting and external reporting, and preparing for contract audits, credentialing, and organization site visits. Performs ongoing compliance monitoring activities. Oversees compliance with incident reporting regulations, external reporting requirements, and coordinates the development of a monthly incident report, and other data reports as needed, to be submitted to the board. Regularly reviews incident reports completed and provides immediate feedback to providers and supervisors regarding timely submission, approval, and compliance with external reporting timelines and requirements. Audits Assists with auditing and monitoring of documentation and referrals in EPIC Carelink. Performs internal chart reviews and audits for 20% of the charts to ensure the client record meets all regulatory, accreditation, and best practices standards. Assists with external audits with state, county, Community Care Licensing, and accrediting bodies. Coordinates and participates in Peer Review and PURQC (Program Utilization Review and Quality Committee) processes. Collaborates with programs, IT, and Finance departments to reconcile services provided and billed. Oversees regional procedure for on-going monitoring of client eligibility, client authorizations, billable/non-billable services and billing errors (violations) across programs. Works with internal departments and external county systems to trouble shoot and correct billing errors. Training/Consultation/Support Provides guidance, training, and consultation to direct service providers and managers related to documentation standards, incident reporting, and billing requirements. Provides support with the credentialing of staff with SFDPH. Participates in leadership meetings including Directors, Supervisors/Managers, and the Health and Safety Committee. Develops internal reporting systems, procedures, and workflows to maximize productivity, efficiency and the efficacy of services, to enhance accessibility for underserved populations, and ensure all new and existing programs are appropriately suited to meet the needs of the diverse communities we serve. HIPAA/Privacy Ensures HIPAA compliance as related to programs with respect to charts/clinical practices and policy implementation. Provides support with records requests and release of information to third parties. Works collaboratively with agency departments to ensure internal/external requirements are met and that agency systems (e.g. Electronic Health Record, Learning Management System, and Payroll System, etc.) are used to meet staff and program needs, increase efficiency, collect/report data, and enhance communication. Maintains relationships with external partners and participates in provider meetings. Responds to county requests in a timely manner and ensures submission of required documents and reports when requested. Performs all other duties as assigned. Core Competencies Decision Making Lead by Example Learning Orientation Personal Effectiveness/Credibility Problem Solving/Analysis Teamwork Orientation Technical Capacity Contributes positively to a healing-centered, respectful workplace by engaging others with humility, care, and a commitment to honoring all identities and lived experiences. Applied Knowledge, Skills, and Abilities BA/BS in Quality Management in Mental Health or related field and 2+ years of relevant experience is preferred, or an AA with 5+ years of relevant experience. Previous experience in behavioral health quality management, regulatory compliance, or utilization review. Solid understanding of Medi-Cal and TJC requirements as they relate to the charting and billing of Mental Health Services. Comfortable working with county leaders as well as leading initiatives that require collaboration with multidisciplinary teams Regional Directors, Psychiatrists, Clinicians, Counselors, & Administrative staff. Excellent oral and written communication skills. Detail-oriented, analytical, and highly organized. Willingness to be a hands-on supervisor. A strong sensitivity to and appreciation for the diverse economic, ethnic, and cultural backgrounds of clients and staff. Highly proficient with MS Office applications (Word, Excel, PowerPoint, Outlook), online literature searches, and electronic database management and reporting. The annual salary for this position is $80,080.00. As part of our team, benefits-eligible employees receive an excellent comprehensive benefits package: 16 days of PTO the first year and more thereafter Nine paid holidays Five health and wellness days off annually 10% additional pay for community-relevant second language fluency Medical/Dental/and Vision plans 403 B Retirement Plan with agency match Employee Assistance Program Commuter Benefits Program Medical and Childcare Flexible Spending Accounts Pet Insurance Identity Theft Protection Plan Paid employee referral program Retention bonuses for many positions Professional licensing fee reimbursement Professional Development reimbursement opportunities Verified Public Service Loan Forgiveness Employer NOTE: The California Department of Public Health (CDPH) has issued new requirements for health care and congregant care facilities to decrease the risk of COVID-19 outbreaks. Based on the CDPH public health mandate, all candidates for positions at Edgewood Center must provide proof of vaccination. Edgewood Center will consider applicants with ADA and Title VII exemptions on a case-by-case basis. Edgewood is proud to be an equal‑opportunity employer. People of color, women, persons with disabilities, and persons who are lesbian, gay, bisexual, transgender, or intersex are encouraged to apply. Edgewood maintains a policy of non‑discrimination with respect to employees and applicants for employment. No aspect of employment will be influenced in any matter by race, color, religion, sex, age, national origin, marital status, ethnicity, religion, sexual orientation, gender identity and/or expression, physical disability (including HIV or AIDS), medical condition, perceived physical disability, veteran status or any other basis prohibited by statute. #J-18808-Ljbffr