Quality Assurance Specialist

Southwest Michigan Behavioral Health•Portage, MI

About The Position

The Quality Assurance Specialist monitors, collects, reviews, and reports data to meet contractual requirements and support continuous improvement projects. The role monitors internal SWMBH measures and data elements, organizes projects, coordinates external audits, and provides subject matter expertise in business process analysis and performance improvement. The position is with Southwest Michigan Behavioral Health in Quality & Clinical Outcomes and may be performed in an office or home environment. It reports to the Director of Quality and is classified as exempt. Compensation is commensurate with experience. The specialist leads or coordinates external audits, develops and monitors partner action plans, supports the annual Quality Assurance and Performance Improvement Program (QAPIP), reviews critical incidents, manages surveys, and analyzes member experience and quality data. The role also reports information to external stakeholders and coaches internal and external customers on quality improvement. If the employee has an active clinical license, the role may include clinical chart reviews and audits of SWMBH providers and CMHSPs.

Requirements

Bachelor’s degree in social work, psychology, organizational psychology, healthcare administration, statistics, or a human services field.
Experience in quality assurance, auditing, and/or project management, with a proven record of leading process improvement projects.
Strong ability to organize, analyze, and present information in verbal and written reports.
Excellent interpersonal skills and ability to work well in teams and independently while managing multiple projects and deadlines.
Advanced Microsoft Office 365 skills, including Word, Excel, Outlook, Visio, and PowerPoint.
Support for culturally competent, recovery-based, person-centered, and trauma-informed practices.

Nice To Haves

Master’s degree with licensure or certification, such as LMSW, LLP, or LPC.
Behavioral health experience involving Intellectual and Developmental Disabilities, Severe Mental Illness, and/or Serious Emotional Disturbances.
Knowledge of quality management and continuous improvement principles.
Experience with Adobe Acrobat, Tableau, Power BI, and electronic medical records.
Life experience with diverse backgrounds and behavioral health issues.

Responsibilities

Identify quality initiatives to improve regional clinical performance, member outcomes, and access to services in line with federal, state, contractual, and accreditation requirements.
Help develop the annual QAPIP Plan and Evaluation and support regional implementation, including KPIs, Performance Improvement Projects, strategic imperatives, and goal tracking across departments.
Review critical incidents to determine sentinel event status, support timely root cause analysis, assist with mortality reviews, and analyze quarterly trends for Critical Incident Reporting System submissions.
Lead and coordinate external audits, including HSAG, MDHHS, and CMHSP site reviews; consult throughout the process, prepare reports, and manage remediation.
Develop action plans with partners to address performance issues and monitor progress.
Manage the SWMBH survey process, including distribution, collection, and communicating outcomes.
Analyze member experience assessments to identify trends in quality, availability, and accessibility of care; recommend, track, and evaluate systemic action steps.
Track and analyze project details and maintain internal systems for projects, audits, and reports.
Report information to external stakeholders in accordance with federal, state, and contractual requirements.
Serve as a subject matter expert on quality assurance and performance improvement and coach internal and external customers on improvement methods.
Manage multiple audits and initiatives simultaneously with strong organization and attention to detail.
If holding an active clinical license, potentially participate in clinical chart reviews and audits of SWMBH providers and CMHSPs.