Compliance and Quality Assuance Specialist

Grafton Integrated Health Network•Cold Spring, MN

41d

About The Position

At Grafton Integrated Health Network, we're committed to ensuring individuals with complex needs receive the highest-quality support. As a Quality Assurance Specialist, you play a key role in maintaining excellence by reviewing documentation, monitoring compliance, and partnering with teams to strengthen service delivery. You'll help foster a culture of accountability and continuous improvement, providing clear feedback and guidance that supports both staff and the individuals we serve. And because we invest in those who drive our mission forward, Grafton provides the tools and professional development you need to grow while making a meaningful impact. Join us - and experience the deep fulfillment of knowing your work truly makes a difference! Be part of a team that leads with heart and grit, the Grafton way-where leadership, compassion, and dedication come together to change lives. The QA Specialist promotes and ensures protections of client rights; conducts investigations into allegations of abuse or neglect; supports activities to ensure compliance with regulatory and accrediting agencies; engages in activities to support the assigned region in continuous quality improvement initiatives; works collaboratively with other Quality Assurance partners to coordinate department activities.

Requirements

Requires a Bachelor's degree in a related field and a minimum of two years related experience providing and reviewing services, investigating allegations of client abuse and neglect, leading quality improvement initiatives, or interpreting and applying licensure standards to human services programs OR
HS/equiv. and a minimum of five years experience in the human services field with at least two years providing and reviewing services, investigating allegations of client abuse and neglect, leading quality improvement initiatives, or interpreting and applying licensure standards to human services programs.
Requires a valid driver's license.
Requires a working knowledge of applicable regulations.
Completion of all required trainings. Maintains all required annual certifications.

Responsibilities

Conducts activities to assure regional compliance with applicable regulatory standards such as Virginia's Department of Education (DOE), Department of Behavioral Health and Developmental Services (DBHDS), as well as contract requirements and payor stipulations. Serves as on-site resource for questions pertaining to regulatory compliance; Supports preparation activities for licensing surveys and supports activities during related external reviews; Maintains copies of licenses required by state and local government.
Conducts activities to assure compliance with all applicable Medicaid requirements such as those related to service delivery, therapeutic passes, client record documentation, and external reporting, Activities include conducting qualitative and quantitative audits, monitoring data, preparing and disseminating data reports for management use. Stays current with relevant Medicaid changes and serves as point of contact for related questions from others and discussions of methods for assuring ongoing compliance.
Conducts activities to assure regional compliance with applicable accreditation standards, such as CARF; Serves as on-site resource for questions pertaining to accreditation compliance; Supports preparation activities for accreditation surveys and facilitates on-site visits by accrediting body; Maintains copy of accreditation on-site.
Conducts audits, as assigned, to support regional and organization continuous quality improvement processes. Audits may involve client documentation, physical environments, employee training/qualifications. Provides audit findings to Executive Director and Quality Assurance Director and monitors for completion of follow up actions identified. Produces data reports as requested by the Director, Quality Assurance and Compliance or Executive Director.
Operates within the organization's electronic client record (ECR) by conducting audits of information/documentation entered, by generating and analyzing data reports produced through the ECR and may participate in the development and training process for ECR use.
Facilitates development of internal and external corrective action plans and monitors implementation of corrective action plans; provides status reports, as requested, to the Director, Quality Assurance and Compliance and Executive Director.
Acts as an objective party to hear concerns or complaints about alleged human rights violations; Investigates and facilitates resolution; Reports complaints as necessary to regional human rights advocate and facilitates external review of such matters; Provides Director, Quality Assurance and Compliance with such data including resolution.
Assures protection of clients' human rights through activities such as review of proposed restrictions, consideration of program guidelines and activities, monitoring use of pat downs and property searches, and ongoing monitoring of implemented environmental/individual restrictions.
Receives reports of alleged abuse or neglect; Notifies Department of Social Services and licensing bodies of allegations of abuse or neglect; Coordinates investigations with external agencies; Conducts internal investigations; Prepares report of investigation findings and makes recommendations for corrective action.
Receives and maintains copies of Serious Incident Notification forms; Ensures processing occurs of serious incidents with corrective action plans, as needed; Produces aggregate data reports of regional serious incidents and submits reports to Director, Quality Assurance and Compliance, regional management team, and Executive Director.
Makes external notifications of certain serious incidents as needed for compliance with regulatory standards and payor requirements. This may involve use of external electronic systems. Conducts investigations into specific incidents and submits written reports to external entities as required.
May supervise one or more employees, assuring training, development, and personnel needs are met for those individuals.
Works in partnership with other Quality Assurance Supervisors to assure efficiency and effectiveness in fulfilling responsibilities.
Provides employee and client training on human rights related issues.
Provides employee training on regulatory compliance, Medicaid compliance, and policies and procedures, as requested.
Acts as resource to program managers in developing strategies for dealing with high-risk situations.
Performs other duties assigned.

Benefits

Medical, dental and vision
Flexible Spending & Health Savings Accounts
Generous Paid Time Off plan & attendance incentives
Employer Paid Life Insurance
Employee Assistance Program (EAP)
Short-term disability (STD)
Long-term disability (LTD)
Paid Career Development - we pay you while becoming certified in CPR, Ukeru, Mandt and other career training!
401(k), including an employer match up to $2,500 annually
Education Assistance up to $5,250 annually
As Grafton is a 501(c)(3) non-profit, you may be eligible for federal student loan forgiveness