DCM Quality Analyst - Clearwater, FL

ENDEAVORS•Clearwater, FL

6d•Onsite

About The Position

Performs routine (journey-level) quality assurance work. Work involves planning, developing, and administering internal quality assurance and compliance activities. Works under moderate supervision, with limited latitude for the use of initiative and independent judgment. Provides physical presence in ensuring Supervisors are in compliance. Develops and oversees case compliance to prevent or address with violations of policy and procedures.

Requirements

Experience in social service financial eligibility determination, auditing, or investigating work.
Graduation from an accredited four-year college or university with major coursework in computer science, computer programming, software engineering, or network administration or a related field is generally preferred.
Knowledge of federal and state program policies and laws, of financial and medical eligibility program policies, and of quality control procedures.
Skill in interviewing, in analyzing data, and in the use of a computer and applicable software.
Ability to apply program and quality control policies and procedures; to ensure compliance with state and federal regulations; to select, analyze, and evaluate information from case records in relation to eligibility criteria; and to communicate effectively.
3+ year’s case management experience serving youth, individuals and families in crisis.
Must maintain regular and acceptable attendance at such level as is determined in the employer's sole discretion.
Driver’s License with clear record required.
Must have daily use of a vehicle without prior notice.
Must pass criminal and child abuse registry background checks.
Must be available and willing to travel to various locations and with such frequency as the business need dictates; including deployment within 24 hours to disaster locations for as long as 2-4 weeks.
Must be available and willing to work nights, weekends and holidays as required to meet business needs.
Must not pose a threat or significant risk of substantial harm to the safety or health of himself/herself or others.

Nice To Haves

Experience with disaster and emergency services a strong plus.

Responsibilities

Develops and implements quality assurance programs.
Plans and organizes case review assignments.
Conducts case and quality control reviews of programs.
Verifies information received from case readings, sources, and clients.
Participates in corrective action planning and service improvement activities.
Identifies cases for investigation of potential fraud and for potential recoupment and restitution.
Reviews and analyzes cases, notes deficiencies, and extracts data to be verified; collects
performance data; identifies adverse trends; and determines compliance with service delivery standards, program requirements, and policies and procedures.
Documents review findings.
Communicates final determination of case review to appropriate staff.
May analyze quality control error findings for trends or patterns.
Performs related work as assigned.
Assist with the development or implementation of compliance-related policies and procedures throughout the DCM Program
Communication, monitoring, or enforcement of all compliance standards.
Report violations of compliance or regulatory standards.
Provide assistance to internal or external auditors in compliance reviews.
Discuss emerging compliance issues with management and/or employees.
Identify compliance issues that require follow-up or investigation.
Conduct scheduled internal reviews or audits.
Conduct or direct the internal investigation of compliance issues.