Program Coordinator II (Waiver QA Reviewer) / 60019056

Program Coordinator II (Waiver QA Reviewer)

The Agency's mission is to be boldly innovative in improving the health and quality of life for South Carolinians. This is position is located in the Bureau of Quality, Richland County. This is an in-office role and not a telecommute or remote position. Are you the One? We are looking for a Program Coordinator II (Waiver QA Reviewer) who will promote the mission and values/behaviors of SCDHHS. With minimum supervision, create training materials, schedule, and perform statewide provider compliance training based on workflow or as assigned by supervisor or program director to ensure adherence with South Carolina Department of Health and Human Services (SCDHHS) policies and procedures, state and federal enrollment requirements, CMS/Medicaid waiver requirements and state regulations. Adhere to HIPPA and privacy laws.

Conducts and documents QA/compliance audits for Home and Community-based Waiver Services (HCBS) to monitor waiver performance measures and CMS quality assurance indicators. Prepares the reviews by setting up survey in Phoenix or other QA related tools per the participant, employee, or provider samples indicated on the QA/Compliance Strategic Plan. Reviews the results/data of reviews conducted by external Quality Improvement Organization (QIO) entities. Develops and implements quality assurance and compliance process improvements in collaboration with external partners and stakeholders. Ensures internal and external policy changes align with quality assurance expectations. Reports provider non-compliance of claims submissions.

Prepares accurate review findings letters, review overview documents, review reports and sends to the provider electronically via Phoenix and/or email. Reviews provider submitted corrective action plans and adjusts final compliance scores accordingly prior to sending final results letter via certified letter and electronic submission. Notifies supervisor of potential sanction of contract termination after initial letter is sent to the provider. Communicates with SCDHHS staff and provider staff appropriately to give policy and compliance instruction as needed.

Contributes to the development and implementation of the quality assurance tools for waiver providers. Monitors updates to waiver documents and related policies and updates tool as appropriate. Documents review data in appropriate tools to facilitate accurate data reporting. Supports the completion and submission of data to Bureau of Policy regarding the review findings.

Attends and participates in relevant opportunities for professional development and training. Demonstrates utilization and application of new skills learned to improve effectiveness and efficiency within assigned responsibilities.

Completes other job duties as assigned. May require performing tasks across other business units within the agency.

The South Carolina Department of Health and Human Services offers an exceptional benefits package for FTE and TGE positions that includes: Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children. 15 days annual (vacation) leave per year. 15 days sick leave per year. 13 paid holidays. State Retirement Plan and Deferred Compensation Programs.

A bachelor's degree in quality assurance, public health, a life science, humanities, or a related field and at least two (2) years of relevant experience. Additional Requirements: In-office role.

Employee must have knowledge of basic principles of quality assurance and the associated statistical tenets. Excellent oral and written communication skills. Good analytical skills. Good mathematics skills. Intermediate-level skills with Microsoft Office applications. Willingness to learn to use a number of different IT systems and their related reporting tools. Ability to prioritize tasks, manage time and work independently.