Quality Assurance Compliance Specialist- Program Specialist Senior

Multnomah County • Portland, OR

5d • Hybrid

About The Position

This recruitment is for the Health Department's Quality Management (QM) and Compliance Program within the Behavioral Health Division. The QM/Compliance Program focuses on quality assurance and quality improvement processes, performance measurement, quality indicators, and monitoring of compliance standards for contracted providers and county behavioral health (BH) services. This position supports contracts and budget reviews for programs, as well as policies and procedures. The role involves providing subject matter expertise on compliance and regulatory requirements for BHD Safety Net Services programs, conducting workflow analysis to identify improvements, identifying and solving problems, monitoring program compliance with Oregon Administrative Rules (OARs), collaborating on training, and participating in Rule Advisory Committee meetings. Additionally, the position monitors legislation impacting programs and provides analysis to senior management. It also involves conducting risk assessments and internal audits, developing and maintaining the BHD Compliance Plan and quality management systems, developing and administering survey instruments, evaluating program effectiveness, and issuing Corrective Action Plans. The role includes conducting investigations of code of conduct, fraud, waste, and abuse allegations, reviewing records, conducting interviews, and writing detailed investigative reports. The position also participates in external audits of Behavioral Health and provider network regional compliance and quality assurance reviews, and reviews program quality control activities over complex contracts, advising senior management on process improvements and providing project management for inter-divisional contract projects.

Requirements

• Equivalent to a bachelor's degree and three (3) to six (6) years of experience that demonstrates the ability to perform the duties of the position. (Equivalency 7-10 years of qualifying training and/or experience).
• Ability to complete Healthcare Basic Compliance Academy within 1st year in the position- ( Health Care Compliance Association)
• Working knowledge of contract compliance criteria and quality indicators.
• Experience in conducting audits or investigations, including data collection, analysis, recommendations for corrective action and compliance monitoring.
• Experience with Medicaid billing, managed care systems, and/or health plans.
• This position requires a background investigation, which may include being fingerprinted.

Nice To Haves

• Certified in Healthcare Compliance (CHC)
• Subject matter expert in quality assurance
• Knowledge of issues faced by those who experience behavioral health challenges and a basic understanding of the full continuum of care for those in need of services.
• Lead with race through actions and advocacy with internal programs, with community partners and across departments throughout the county.
• Demonstrate the ability to flex style in order to be effective across cultural context.
• Respect and appreciation for ethnic and cultural diversity.
• Ability to collaborate and build relationships to achieve positive work outcomes.
• Ability to maintain a safe and healthy workplace.
• High degree of resilience, is outcome driven, and can thrive in an environment of rapid change while managing pressure in an effective and professional manner.

Responsibilities

• Provide subject matter expertise on compliance and regulatory requirements for BHD Safety Net Services programs.
• Conduct work flow analysis to identify areas for improvement, simplify redundant processes, and address quality assurance/compliance requirements.
• Identify problems and formulate solutions independently or through consensus with Oregon Health Authority (OHA) and BHD.
• Identify trends and issues presenting in multiple systems and facilitate communication/meetings regarding systems issues (including with OHA and County Systems).
• Formulate corrective action strategies as needed.
• Collect and analyze information concerning the implementation of policy decisions, and analyze the effect of policy decisions upon service delivery and operations.
• Monitor program compliance with Oregon Administrative Rules (OARs) regarding provision of services, standards of care, and patient safety.
• Collaborate with Safety Net Services Leadership and staff on planning and coordinating ongoing training.
• Provide technical assistance when needed/requested by the Safety Net Services Unit.
• Participate in Rule Advisory Committee meetings and provide engagement with rule changes, including in-person meetings, written feedback and comments and communication back to the team about how rule changes may impact work/workload.
• Annually, during the legislative session, monitor legislation having an impact on programs; prepare policy statements on legislative topics.
• Provide Senior Management analysis and assessment of how legislation will impact compliance related activities for programs in the Division.
• Conduct Risk Assessments and internal Audits of BHD programs when issues arise, or on a predetermined schedule per Compliance Plan.
• Develop, implement, and maintain BHD Compliance Plan, quality management plans and systems to ensure compliance and achieve program outcomes.
• Develop and administer sophisticated survey instruments to evaluate program effectiveness and recommend proposals based on data-driven analysis.
• Develop program evaluation criteria; collect data to evaluate program performance based on rules, regulations, guidelines, goals and objectives; analyze and prepare formal assessments and reports of BHD programs; make program recommendations based on research and analysis conducted.
• Issue Corrective Action Plans as indicated.
• Monitor compliance with any recommendations or Corrective Action Plans.
• Work with other members of the Quality Management team to provide technical assistance to programs negotiating Corrective Action plans.
• Conduct investigations of code of conduct, fraud, waste and abuse allegations.
• Review mental health treatment records, operational records and conduct interviews.
• Compile and analyze all investigative findings in order to reach a conclusion regarding allegations.
• Write detailed investigative reports summarizing findings and supporting conclusions and recommendations for corrective action.
• Work with the County Attorney’s office, Human Resources, the Protected Class Complaint office, leadership and the Quality Management team to evaluate reports of misconduct, fraud, waste or abuse allegations to determine the appropriate course of action, and role delineation.
• Participate in Behavioral Health and provider network regional compliance audits and quality assurance reviews.
• Work as a team member with the rest of the Quality Management team to compile operational documents, policies, and client files for submission for audits of BHD.
• Review program quality control activities over complex contracts with high levels of funding at risk.
• Conduct analysis on contract best practices and trends and formulate recommendations.
• Advise senior management on policy and organizational issues with contract process and make recommendations for process improvement.
• Identify problems and formulate solutions independently or through consensus with stakeholders; provide project management on inter-divisional contract projects; consult with programs in BHD to assist with their development and implementation of training for revised or new business systems or processes.

Benefits

• employer-funded retirement savings
• health and dental insurance at very low cost to full-time employees and their dependents
• paid parental leave
• wellness programs
• a focus on work-life balance

What This Job Offers

• Job Type: Full-time
• Career Level: Senior