Quality and Advocacy Specialist

Hills & Dales Child Development Center•Dubuque, IA

1d•Hybrid

About The Position

The Quality & Advocacy Specialist is responsible for referrals, admissions, and discharges and quality assurance for services. This role serves as the principal advocate for clients, working as a liaison between individuals and service agencies pertaining to services, records, payers, etc. Develops strong relationships with individuals/agencies in soliciting and receiving referrals while advocating for the most appropriate services and supports. This position is responsible for reviewing and analyzing client case records, performing audits of compliance-related procedures, and examining care delivery methods to ensure compliance standards are met in accordance with Iowa Administrative Code, CARF and the Hills & Dales mission.

Requirements

Knowledge of applicable federal, state and local laws, guidelines and trends that govern the agency, MCO/Medicaid rules and CARF standards.
Strong analytical and problem-solving skills.
Ability to take initiative, maintain confidentiality, meet deadlines, and work in a team environment are essential.
Demonstration of advanced proficiency with computer systems and software, including Microsoft platform, electronic documentation and medical record systems.
Ability to establish professional and respectful interpersonal relations with staff, residents, consumers, families, community, and other service providers.
Gives close attention to detail using problem solving and critical thinking to identify solutions to deficiencies.
Demonstration of strong administrative and organizational skills.
Demonstration of acceptable levels of attendance, punctuality, and work ethic such that the job performance meets or exceeds expectations.
Ability to work flexible hours and to travel.
Bachelor's degree from a four-year college or university in a human services or health-related field.
Free of a conviction or prior employment history of child or resident abuse or dependent adult abuse.
Must have an active driver's license with a minimum of 3 years' experience in driving.
For use of personal vehicles, one must maintain an appropriate level of insurance.

Nice To Haves

Previous experience with HCBS Waiver services preferred.

Responsibilities

Spends time with persons receiving services observing the support, treatment and opportunities offered and delivered to clients.
Focuses attention on dignity, privacy, and self-esteem issues.
Provides information and education to individuals and families regarding guardianship.
Actively pursues guardianship for individuals not having adequate family involvement/support to formalize a legal commitment.
Participates in client/parent/guardian complaint resolution supports.
Follow up staff training as requested.
Maintains contact with persons receiving services, parents/guardians as requested.
Keeps parents/guardians informed regarding agency practices and policies.
Supports individuals, parents/guardians by maintaining routine availability.
Returns phone calls promptly.
Communicates regularly with team staff.
Provides support, information/education, minor counseling and referrals to individuals, parents, and guardians.
Prepares and maintains other required reports and records.
Maintains routine contacts with IME, IHHS, Case Management, and MHDS Regions & MCO's regarding individuals' status, needs and opportunities.
Encourages involvement and active participation from parents/guardians and other pertinent entities in admission, IPP, and discharge processes.
Maintains a working knowledge of services and resources that are available.
Readily refers individuals to appropriate outside agency resources when necessary.
Participates in determining individual ineligibility/discharge determinations along with other admissions committee members.
Supports persons receiving services, parent/guardians, families, and staff experiencing grief related to major transitions, discharges, or death.
Assures clients have person/entity identified for representative payee status.
Make application for Hills & Dales to become representative payee as requested.
Participate in Social Security interviews as scheduled.
Monitors rep payee account balances as requested.
Facilitates disability determination and/or re-determination documentation.
Maintains working knowledge of client's entitlements/insurances and personal money status.
Upon the discharge/death of a client, will work with Social Security and other entities regarding personal monies.
Performs other identified tasks relating to client entitlements/benefits as assigned.
Completes quality assurance checks on ICF client documentation to assure compliance per Iowa Administrative Code.
Reviews client programming books to ensure compliance with HCBS requirements.
Uses knowledge of individuals' strengths, needs, likes, dislikes and reinforcements and applies it to analysis of observations and documentation.
Maintains knowledge of individuals appropriate behavior, goals, supports and skills; confirms that staff are supporting and documenting according to plan.
Assures documentation contains and consists of required elements to meet billing, state, and federal requirements.
Ensures individuals choices are notable in documentation.
Develops and uses dashboards and compliance reports to conduct analyses of data collected from documentation, audits, and observations.
Assists departments and Health & Safety Committee with completing audits and observations for critical areas of programming, health services and safety.
Works with appropriate parties to develop performance improvement plans that address noted deficiencies in documentation and audits of critical areas.
Fosters a non-punitive culture for addressing areas of improvement, performing root cause analysis, and supporting subsequent change processes.
Follows established guidelines for required reporting of safety and health concerns noted in documentation or care observation.
Observes the physical and mental health changes of individuals and takes appropriate action in the event a health change is noted in documentation.
Evaluate incident/behavior reports as needed or requested and reports findings to appropriate team member/supervisor.
Maintains confidentiality of information.
Complies with HIPAA privacy and confidentiality procedures and standards as identified in the agency policy.
Assists in monitoring compliance with MCO/Medicaid, state, federal and local regulations, as well as CARF accreditation standards.
Participates in meetings as needed or requested.
Performs miscellaneous duties as assigned.