Position: Clinical Quality Assurance Specialist
Pay Range: DOE + $5000 sign-on bonus
The Quality Assurance Specialist is primarily responsible for development and implementation of internal quality measures to mitigate risk of non-compliance with external laws and regulations, as well as ensure excellence in service delivery.
Duties and Responsibilities:
- Maintains a working knowledge of regulations and guidance from Alaska Department of Health and Social Services (DHSS), Department of Behavioral Health and Development Services (BHS), CARF, HRSA 19 Standards, Medicare, Medicaid and FTCA requirements.
- Demonstrates the ability to analyze and apply multiple sets of regulations and standards to service delivery and documentation requirements.
- Collaborates with the COO, CCO, Director of Behavioral Health, and other Leadership team members as needed to develop a process for the review of records of persons served, ensuring compliance with the applicable regulations and laws as well as exemplifying adopted best practices.
- Provides hands on support to staff for implementing the peer review process by tracking, notifying appropriate staff, and facilitating the review.
- Conducts internal reviews of records of persons served at established intervals in addition to the routine department reviews, to ensure quality of records as well as the effectiveness of the review process and tools. Develops and maintains an agency tracking system for these reviews to maintain consistency and readiness for external reviews/audits and assures that all internal reviews meet the internal audit requirements in the updated Medicaid regulations.
- Monitors incoming audit requests for records and reviews documentation selected by Medical Records for submission, monitors audits for results, and provides feedback to Leadership, Supervisors, and staff to address areas of findings or concerns.
- Stays current with information regarding audit trends and uses the information to suggest charting changes/improvements.
- Provide tracking for all reviews and organizes reviews according to schedule. Analyzes the findings in an effort to identify trends and practices that are exemplary or needing improvement, and conducts training to individuals or groups as needed.
- Collaborates with the CCO and department heads to address compliance concerns in relation to laws, regulations and standards as necessary.
- Generate recommendations for changes to procedures, forms and policies to improve regulatory compliance and assist in implementation as needed.
- Engages with staff across all departments of the organization in a strength-based manner to ensure compliance, develop best practices, identify areas for additional support and create a culture of shared ownership and engagement in quality improvement.
- Integrate the findings of external audits or licensure findings and policy changes to the internal quality review process.
- Develop and maintain an agency tracking system for internal quality reviews to maintain consistency and readiness for external reviews/audits.
- Assist in Monitoring, implementing, and ensuring compliance with appropriate risk management protocols and HIPPA.
- Master’s Degree in Social Work, Psychology, Counseling, Nursing, or related field. (Bachelor’s degree with extensive experience in behavioral health quality assurance will be considered.)
- License status preferred.
- Five years of experience working in behavioral health.
- Two years of experience working in quality improvement assurance.
- Ability to communicate effectively, both orally and in writing and to relate in a positive and courteous manner that promotes cohesiveness and cooperation.
- Ability to function independently.
- Ability to relate to staff, clients and the community in a cooperative, courteous, and timely manner.
- Ability to work well under pressure and maintain focus and composure when faced with tight or changing deadlines and priorities.
- Strong understanding of Medicare and Medicaid regulations and requirements, state licensing, and accreditation regulations and processes.
- Excellent organizational and time management skills.
- Ability to work effectively with people from diverse backgrounds.
- Ability to work a flexible work schedule if/as needed.
- Ability to utilize MS Office and learn a variety of software.
- Current driver’s license; clear driving record
- Current tuberculosis screening test result
- First Aid and CPR certifications must be obtained within 2 weeks of hire. CPI (Nonviolent Crisis Intervention) certification must be obtained when offered through the agency; may substitute current MANDT certificate for CPI.
All qualified candidates who meet or exceed the above Position Qualifications or have relevant experience will be contacted.
AES provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. While working within the parameters of an Alaska Native Organization, hiring preference will be given to shareholders/spouses/descendants and other Alaska Natives in accordance with Public Law 93-638.
AES matches job seekers with opportunities in which they are recognized and rewarded for their experience, skills and abilities. AES is proud to be an Alaskan-owned company building relationships on integrity and trust since 1977. Our Services are always FREE to candidates.
POSITION OPEN UNTIL FILLED