Quality Assurance Risk Management Coordinator

Commonwealth of Pennsylvania • Dauphin County, PA

8d • Hybrid

About The Position

Step into a role where your careful thinking can spark real progress! As a Quality Assurance Risk Management Coordinator for the Department of Human Services, you will evaluate programs and help improve the quality of behavioral health services. You will work with partners who share a commitment to strong, reliable care. Your contributions will lead to better results for communities across the state. This position supports the improvement of behavioral health services by reviewing information, evaluating program performance, and working with partners across the Commonwealth.

Requirements

• One year as a Quality Assurance/Risk Management Specialist (Commonwealth job title or equivalent Federal Government job title, as determined by the Office of Administration)
• Three years of professional experience as a member of a multiple disciplinary treatment team in a public or private health care facility and a bachelor's degree
• Three years of clinical experience in a human services agency, including two years of administrative, evaluative, consultative or supervisory work in a health care program; and a bachelor's degree with major course work in social work, nursing, health care administration, behavioral sciences or a related field
• Any equivalent combination of experience and training
• Meet the PA residency requirement
• Be able to perform essential job functions

Responsibilities

• Examine contractor and managed care operations for compliance with federal and state rules
• Assess documents and reports to determine if standards, goals, and benchmarks are met
• Review service decisions and related documentation for clarity and adherence to medical necessity requirements
• Lead audits and interviews to evaluate access, quality, and risk in behavioral health services
• Work with internal and external partners on quality reviews and clinical best practices
• Study legislative and regulatory changes and interpret their impact on behavioral health services

What This Job Offers

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