Quality Assurance/Quality Improvement Specialist

COMMUNITY HEALTH OF SOUTH FLORIDA INC•Miami, FL

About The Position

Ensures 100% compliance with all agency policies and procedures. Advises Senior Management on appropriate changes and their implementation within the Behavioral Health Services. Provides training, tools, and other techniques to enable the department to achieve excellence and compliance with all contracts, Joint Commission Accreditation Health Organization and Regulatory Agencies. Coordinates all Quality activities that are required within Behavioral Health Services to meet its customers and agency expectations. Acts as a liaison between HMO’s and Behavioral Health Services. Ensures compliance with all aspects of clinical care in all departments within Behavioral Health Services. Provides administrative oversight of the department in the absence of the Vice President for Behavioral Health Services.

Requirements

Graduate from an accredited College or University with a minimum of a Bachelor’s Degree in Behavioral Science or related field.
At Three (3) years minimum experience in healthcare program development, project planning and implementation.
Proven experience in case management, treatment plan development, mental health/substance abuse, quality improvement, and training.
Experience working with culturally diverse clients.
Knowledge regarding the Joint Commission and Regulatory Agency requirements.
Maintain CPR certification from the American Heart Association.
Possess knowledge in behavioral sciences, social work, and quality assurance and performance improvement methodology.
Proven the ability to effectively manage professional–level employees and build appropriate work relationships with staff members.
Able to effectively communicate, orally and in writing.
Excellent interpersonal communication skills; proven ability to problem-solve and be solutions-oriented.
Excellent organizational and administrative skills.
Strong ability to work independently as well as a team member with fellow co-workers, supervisors, and agency staff.
Demonstrated flexibility in work schedule and job assignments; ability to work long and unpredictable hours at times.
Working knowledge of Quality Assurance and Performance Improvement standards and procedures.

Nice To Haves

Master's in Counseling or related field or equivalent preferred as a direct service provider in a social work setting.

Responsibilities

Evaluates and reviews the quality and appropriateness of client care and services; identify improvement opportunities; resolve deficiencies in collaboration with clinical staff and senior management.
Service as the Chairperson for Seclusion and Restraint Committee in CSU.
Sets Quality Assurance (QA) compliance objectives and ensures that targets are achieved. Promotes and implements quality assurance and performance improvement activities throughout the Behavioral Health Care Department.
Meets regularly with the Director of Behavioral Health to coordinate QA activities; maintains oversight of program compliance and awareness of budgetary control issues.
Ensures compliance with local, state and national standards/legislation to include health safety standards.
Develops and implements training modules on QA to include performance monitoring, clinical documentation, data submission, and reporting.
Identifies areas of risks; develop and implement corrective action plans and reports; analyze technical guidance and training on privacy, confidentiality, accreditation standards, and grants requirements.
Monitors progress of QA measurements and State-wide Dashboard Indicators. Makes recommendations for improvement.
Conducts routine chart audits for compliance with Medicaid HMO’s and HMO’s and Medicare standards and other fiduciary agencies; report findings and assigns responsibility as well as assist in drafting corrective plans.
Serve as the Department of Data Liaison for the Incident Report System and Seclusion and Restraint Analysis System (IRAS).
Act as the Single Point of Contact (SPOC) for the DCF ADA Program.
Representative for CHI Trauma Informed/CARE Chair Committee.
Covers for other Coordinators during leave or during time of vacancies.
Covers the administrative duties for Behavioral Health Services during Vice President’s absence.
Coordinates all record request from funding sources and regulatory bodies.
Schedules and facilitates all on-site monitoring with HMO and other regulatory bodies.
Coordinates all record requests from funding sources and regulatory / credentialing agencies.
Supervisor for Behavioral Health Access Program (Florida Access).
Aids Crisis Stabilization Unit (staffing, policies, and clinical documentation).
Dispute authorizations that have been denied by HMO.