Quality Assurance Risk Management Coordinator

THE POSITION

The Quality Assurance Risk Management Coordinator role with the Department of Human Services offers you the chance to make a real impact on behavioral health services across Pennsylvania. This position helps strengthen oversight, improve service quality, and support positive outcomes for individuals who rely on Medicaid behavioral health programs. It is a meaningful career path for someone who wants to support strong systems and better access to care!

DESCRIPTION OF WORK

This position helps ensure that Medicaid Behavioral Health services are delivered with quality, consistency, and accountability across the HealthChoices program. It involves reviewing data, evaluating program practices, and supporting quality improvement efforts. As a Quality Assurance Risk Management Coordinator, you will perform the following duties: Compliance Reviews: Review contractor operations and documentation for alignment with state and federal requirements. Performance Evaluation: Assess quality management plans, evaluations, and program descriptions to confirm benchmarks and standards are met. Risk Identification: Identify service delivery risks through review of complaints, grievances, and service denial decisions. Onsite Audits: Lead onsite reviews with program partners to examine service quality, access, and adherence to medical necessity. Collaboration Work: Coordinate with internal teams and external partners to advance quality initiatives and improve behavioral health outcomes. Data Reporting: Analyze submissions and prepare written and statistical reports that highlight trends and support decision making.

WORK SCHEDULE AND ADDITIONAL INFORMATION

Full-time employment. Work hours are 8:00 AM to 4:30 PM, Monday–Friday, with a 60‑minute lunch. Telework: You may have the opportunity to work from home part‑time. You will be required to report to 303 Walnut Street Harrisburg, PA 17101, as listed in this posting two days per week. To telework, you must have a securely configured high‑speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg. The ability to telework is subject to change at any time. Additional details may be provided during the interview. Salary: In some cases, the starting salary may be non‑negotiable.

QUALIFICATIONS

Required Experience, Training & Eligibility One year as a Quality Assurance/Risk Management Specialist (Commonwealth job title or equivalent Federal Government job title, as determined by the Office of Administration); or Three years of professional experience as a member of a multi‑disciplinary treatment team in a public or private health care facility and a bachelor's degree; or Three years of clinical experience in a human services agency, including two years of administrative, evaluative, consultative or supervisory work in a health care program; and a bachelor's degree with major coursework in social work, nursing, health care administration, behavioral sciences or a related field; or Any equivalent combination of experience and training. Other Requirements You must meet the PA residency requirement. For more information on ways to meet PA residency requirements, follow the link and click on Residency Guidelines. You must be able to perform essential job functions.

EOO STATEMENTS

Telecommunications Relay Service (TRS): 711 (hearing and speech disabilities or other individuals). If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date. The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply. Veterans: Pennsylvania law (51 Pa. C.S. § 7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to and click on Veterans. #J-18808-Ljbffr Commonwealth of Pennsylvania