CII HCR QA Reviewer

TX-HHSC-DSHS-DFPS • Austin, TX

1d • Remote

About The Position

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage.

Functional Title: CII HCR QA Reviewer Job Title: Quality Assurance Spec III Agency: Health & Human Services Comm Department: Quality Assurance Posting Number: 14215 Closing Date: 03/11/2026 Posting Audience: Internal and External Occupational Category: Healthcare Practitioners and Technical Salary Range: $5,521.16 - $6,779.25 Pay Frequency: MonthlySalary Group: TEXAS-B-20 Shift: Day Additional Shift:  Telework: Eligible for Telework Travel: Up to 5% Regular/Temporary: Regular Full Time/Part Time: Full time FLSA Exempt/Non-Exempt: Nonexempt Facility Location:  Job Location City: AUSTIN Job Location Address: 701 W 51ST ST Other Locations:  MOS Codes: No military equivalent    Quality Assurance Spec IIIThis Position schedule is Monday - Friday 10 AM - 7 PM.
Serves as a Quality Assurance Monitoring Specialist with the Quality Assurance Unit. Quality Reviews include Long Term Care, Home and Community Support Services Agency (HCSSA), Health Care Regulation/Acute Care (HCR), and Substance Abuse/Narcotic Treatment Program complaints and self-reported incidents. Reviews daily intakes of all allegations of abuse, neglect, and exploitation received by intake specialists to determine if it is a violation and to ensure timely and accurate triage and prioritization. Edits reports prepared by intake specialists prior to sending electronically to the regional offices for Investigation and to ensure quality control and accountability standards are maintained. Analyzes and interprets Regulatory Services policies, procedures and regulations. Provides consultation to agency staff, providers, advocates, consumers, legislators and other agencies. Serves as a liaison between the Complaint Intake Unit and regional field operations staff. Assists with the intake of complaints, incidents, and requests for information. Performs related work and may participate in special projects and workgroups as assigned. Interprets policies, procedures, rules, regulations and standards and communicates on a complex level with others to exchange or verify information, respond to inquiries, address issues or resolve problems. Performs other duties as assigned.

Requirements

• Knowledge of state and federal laws and regulations related to regulatory programs.
• Knowledge of health care principles, practices, and procedures.
• Ability to effectively communicate, organize and present information, with others orally and in writing to provide information.
• Ability to present professional and knowledgeable information to internal and external stakeholders.
• Ability to use judgment, make effective decisions and prioritize work.
• Ability to analyze and solve problems.
• Required either a Bachelor's or Associates degree from an accredited college or university or Nursing Licensure (RN/LVN) from a university or nursing program.
• Any one of the following Registrations, License Requirements or Certifications are required: Licensed Vocational Nurse (LVN) or Registered Nurse (RN), SMQT, Medical Technologist/Laboratory Technician, Surgical Assistant, Emergency Medical Technician, End Stage Renal Disease/Dialysis Technician, Other License/Degree/Certification in Health Care.
• Applicant must be able to work Monday through Friday 10 AM to 7 PM.

Nice To Haves

• Any one of the following are preferred Registrations, License Requirements or Certifications: Licensed Vocational Nurse (LVN) or Registered Nurse (RN), SMQT, Medical Technologist/Laboratory Technician, Surgical Assistant, Emergency Medical Technician, End Stage Renal Disease/Dialysis Technician, Other License/Degree/Certification in Health Care.
• Experience in Long Term care Program, HCSSA Program, or Acute Care Program Preferred.

Responsibilities

• Performs quality assurance reviews of long-term care and non-long-term care complaints, incidents, and addendums to ensure accuracy/compliance with applicable Federal and State regulations. Performs appropriate routing of intakes based on program type and expected time frames.
• Evaluates long-term care and non-long-term care complaints and incidents related to abuse/neglect/exploitation of children, elderly, individuals with mental illness, or individuals with intellectual disabilities to ensure the assigned priority is in alignment with Federal and/or State regulations. This process includes notifying regional staff of 24-hour priority or 2-day priority intakes.
• A Quality assurance review ensures appropriate triage of priority, facility patient history, allegations, grammar, punctuation, spelling, and conditions of participation/coverage, if applicable.
• Interprets non-long-term and long-term care policies, procedures, rules, regulations, and standards for individuals within Complaint and Incident Intake.
• Performs quality assurance reviews for non-jurisdictional intakes (CI Tickets) to ensure the facility/agency is within Federal or State Jurisdiction.  When found to be non-jurisdictional, the intake is referred to another applicable agency, such as the Ombudsman, the Joint Commission, or the Medical Board.
• Communicates on a complex level with others (internally or externally) to provide, exchange, or verify information; answer inquires, address issues or resolve problems.
• Provides complex professional and technical assistance/consults to others on policies, procedures, rules, regulation, standards, or requirements.
• Maintains current knowledge in assigned areas by reviewing literature, attending meetings/seminars/work groups/trainings, or communicating with other professionals.

Benefits

• comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees
• defined benefit pension plan
• generous time off benefits
• numerous opportunities for career advancement

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree