Quality Assurance Risk Management Coordinator

Commonwealth of Pennsylvania • Dauphin County, PA

3d • Hybrid

About The Position

The Quality Assurance Risk Management Coordinator role with the Department of Human Services offers you the chance to make a real impact on behavioral health services across Pennsylvania. This position helps strengthen oversight, improve service quality, and support positive outcomes for individuals who rely on Medicaid behavioral health programs. It is a meaningful career path for someone who wants to support strong systems and better access to care! This position helps ensure that Medicaid Behavioral Health services are delivered with quality, consistency, and accountability across the HealthChoices program. It involves reviewing data, evaluating program practices, and supporting quality improvement efforts.

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
• Able to perform essential job functions

Responsibilities

• Review contractor operations and documentation for alignment with state and federal requirements
• Assess quality management plans, evaluations, and program descriptions to confirm benchmarks and standards are met
• Identify service delivery risks through review of complaints, grievances, and service denial decisions
• Lead onsite reviews with program partners to examine service quality, access, and adherence to medical necessity
• Coordinate with internal teams and external partners to advance quality initiatives and improve behavioral health outcomes
• Analyze submissions and prepare written and statistical reports that highlight trends and support decision making

What This Job Offers

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