Quality Assurance Specialist III

TX-HHSC-DSHS-DFPS•Pittsburg, TX

4d•$6,101 - $6,779•Hybrid

About The Position

This position schedule is Monday through Friday, 10:30 AM to 7:30 PM. Serves as a Quality Assurance Monitoring Specialist with the Quality Assurance Unit. Quality Reviews include Long Term Care and Home and Community Support Services Agency (HCSSA) complaints and self-reported incidents. Reviews daily intakes of all allegations of abuse, neglect, and exploitation received by intake specialists to determine if it is a violation and to ensure timely and accurate triage and prioritization. Edits reports prepared by intake specialists prior to sending electronically to the regional offices for Investigation and to ensure quality control and accountability standards are maintained. Analyzes and interprets Regulatory Services policies, procedures and regulations. Provides consultation to agency staff, providers, advocates, consumers, legislators and other agencies. Serves as a liaison between the Complaint Intake Unit and regional field operations staff. Assists with the intake of complaints, incidents, and requests for information. Performs related work and may participate in special projects and workgroups as assigned. Interprets policies, procedures, rules, regulations and standards and communicates on a complex level with others to exchange or verify information, respond to inquiries, address issues or resolve problems. Performs other duties as assigned.

Requirements

Knowledge of state and federal laws and regulations related to regulatory programs.
Knowledge of health care principles, practices, and procedures.
Ability to effectively communicate, organize and present information, with others orally and in writing to provide information.
Ability to present professional and knowledgeable information to internal and external stakeholders.
Ability to use judgment, make effective decisions and prioritize work.
Ability to analyze and solve problems.
Required either a Bachelor's or Associates degree from an accredited college or university or Nursing Licensure (RN/LVN) from a university or nursing program.
Applicant must be able to work Monday through Friday, 10:30 AM to 7:30 PM.

Nice To Haves

Experience in Long Term care Program, HCSSA Program, or Acute Care Program Preferred.

Responsibilities

Performs quality assurance reviews of long-term care and non-long-term care complaints, incidents, and addendums to ensure accuracy/compliance with applicable Federal and State regulations. Performs appropriate routing of intakes based on program type and expected time frames.
Evaluates long-term care and non-long-term care complaints and incidents related to abuse/neglect/exploitation of children, elderly, individuals with mental illness, or individuals with intellectual disabilities to ensure the assigned priority is in alignment with Federal and/or State regulations. This process includes notifying regional staff of 24-hour priority or 2-day priority intakes.
A Quality assurance review ensures appropriate triage of priority, facility patient history, allegations, grammar, punctuation, spelling, and conditions of participation/coverage, if applicable.
Performs quality assurance reviews for non-jurisdictional intakes (CI Tickets) to ensure the facility/agency is within Federal or State Jurisdiction. When found to be non-jurisdictional, the intake is referred to another applicable agency, such as the Ombudsman, the Joint Commission, or the Medical Board.
Communicates on a complex level with others (internally or externally) to provide, exchange, or verify information; answer inquires, address issues or resolve problems.
Provides complex professional and technical assistance/consults to others on policies, procedures, rules, regulation, standards, or requirements.
Maintains current knowledge in assigned areas by reviewing literature, attending meetings/seminars/work groups/trainings, or communicating with other professionals.