Quality Assurance Administrator

Community Solutions for Children, Families and Individuals•Gilroy, CA

20h•Onsite

About The Position

Since its founding as a teen drop-in center in 1972, Community Solutions (CS) has grown in both depth and breadth of services in response to the growing and changing needs in the community. As one of the most comprehensive nonprofit human services agencies in Santa Clara County and the surrounding areas, CS provides prevention, intervention, treatment, and residential services to more than 6,400 clients annually, helping them overcome the challenges posed by mental health issues, substance abuse, trauma, severe family dysfunction, sexual and domestic violence, and human trafficking. Under the general direction of the Director of Quality Assurance and Compliance, the Quality Assurance Administrator II provides comprehensive data analysis and reports generation in addition to monitoring and evaluating documentation standards, service provision and other projects and processes to support behavioral health programs and other agency operations. Responsibilities include monitoring the integration of best practices and cost-effective services; assists with creating, facilitating, and training procedures that guide staff in compliance with regulatory, accreditation and payor standards; serving as a representative for Community Solutions on County committees; and supports Operations division with other needs, as necessary. The Ideal Candidate Will Possess the Following Qualifications and Knowledge: Did you know that research shows that women and people from underrepresented groups often apply to jobs only if they meet 100% of the qualifications? Please understand that no one ever meets 100% of the capabilities. If much of this describes you, we encourage you to apply. This might be the right next role for you if you have:

Requirements

A.A. Degree or equivalent and two (2) years of related office experience majority must be in behavioral health, human services, or similar setting.
Experience handling large projects using data collection, tracking processes, generating reports, and systems management.
Demonstrated ability to input data using systems and practices and handle large amounts of data collection.
Produce useful reports and effectively communicate analysis of data.
Demonstrated ability to input data, develop data collection systems and practices, and synthetize information into useful reports.
Utilize continuous improvement systems.
Group facilitation skills and the demonstrated ability to work collaboratively with others.
Customer service skills to support the monitoring of treatment services; maintenance of clinical and fiscal records and systems;
Understanding of the interdependency and competing demands of organizational support departments, clinical and managerial staff, and external customers.
Ability to adapt to changing regulatory, accreditation or other agency requirements.
Knowledge of project management and computer proficiency required.
Must be able to receive a criminal record clearance as required by specific programs, funding requirements and licensing regulations.
Requires an automobile to perform routine job duties and requires the willingness and ability to transport clients in your own vehicle.
A valid CA driver’s license or ability to obtain CDL, current car insurance and a good driving record as documented by a DMV report and consistent with the Agency’s liability insurance requirements is required.
Please note that Community Solutions has adopted a COVID-19 vaccination policy to safeguard the health and well-being of our employees and clients. As a condition of employment, Community Solutions employees are required to be fully vaccinated for COVID-19, unless a reasonable accommodation is approved or as otherwise required by law.
Candidates for this position must be legally authorized to work directly as an employee for any employer in the United States without visa sponsorship.

Nice To Haves

Experience with applicable software to gather statistical data, Medi-Cal Billing, and Electronic Medical Records systems is highly desirable.

Responsibilities

Takes a lead role in overseeing audits and site certifications.
Produces and verifies the accuracy of reports.
Synthesizes and analyzes program performance indicators developed by the QA and Outcomes & Evaluation (O&E) teams.
Facilitates their consistent use across all assigned programs.
Provides training to others to support the use of data in managing, reporting, and analysis skills of others.
Supports the current Quality Improvement dashboards by creating monthly director level reports and analysis of program audit results.
Creates, implements, and monitors Continuous Quality Improvement (CQI) activities.
Partners with program management to provide coaching and training related to documentation of CQI activities.
Participates in CQI workgroups and project teams as assigned.
Implement agency plan for external Medi-Cal auditing, including Agency licensing and accreditation.
Implement and leads project and change activities and internal audit procedures.
Investigate, analyze, and report compliance related issues including suspected fraud, breach of protected health information, etc.
Implement service verification processes to identify individuals or entities engaged in potential fraud and abuse.
Conducts service verification calls with clients to verify services occurred.
Receives, tracks, and monitors resolution of consumer/family complaints regarding services.
Reviews reports and monitors account transactions that are potentially fraudulent.
Support agency initiates by tracking and analyzing individual and program follow through in a project plan and compliance with plan of corrections.
Implements and development of utilization management protocols and review systems.
Monitors compliance with established procedures for internal audits of Medi-Cal services and clinical programs; provides analysis of summary reports; provides feedback to support CQI of audit processes.
Obtain, investigate, analyze, and track adverse incidents; ensure reports are distributed properly and follow up action is taken to resolution.
Investigate, analyze, and report compliance related issues including suspected fraud, breach of protected health information, etc.
Presents findings of service verification analyses to Employee Relationship and Division Directors to determine in next steps.
Presents information that supports whether employee behaviors reflect performance or conduct issues.
Generate monthly, quarterly, and annual reports with analysis and recommendations; provide reports as needed to management.
Responsible for the development and implementation of protocols, systems and identifying training needs to assist staff to comply with contractual, regulatory, accreditation and excellent practice and standards, while monitoring compliance.
Develops job aids: using sequence ordered details and screenshots, publishes overviews of processes used at the program, division, and agency level.
Participates and occasionally leads agency projects to support continued quality improvement throughout the agency.
Attends and participates in Agency and team meetings as required.
Attends and participates in County meetings and workgroups as necessary.
Successfully completes all training within the required time frame.
Utilizes personal or agency vehicles for company business, as needed.
Other QA and Compliance duties as assigned.

Benefits

Community Solutions offers a competitive and comprehensive rate of $25 per hour, a generous employee benefits package, and encourages a strong work-life balance.
We believe in supporting the whole person by providing:
100% of premiums paid by employer for full-time employees and eligible dependent children
403(b) Retirement Plan with 5% employer match
3-weeks paid vacation to start
13 paid holidays; 96 sick hours per year (inclusive of self-care/mental health days)
Longevity bonuses
Generous family medical leave for eligible employees
Student Loan Forgiveness Program
Staff learning and development and robust in-house training opportunities
Employee-led Diversity, Equity, and Inclusion Resource Group