Quality & Compliance Manager - Outpatient Services

State of Colorado•Denver, CO

1d•Hybrid

About The Position

This position is open to current Colorado residents only. Civil and Forensic Mental Health Services (CFMH) operates Colorado’s two mental health hospitals, the Forensic Services Division, the Division of Mental Health Transitional Living, and now the Outpatient Services Division. The office provides a continuum of mental health care for both Civil and Forensic clients. Civil clients are individuals who are committed by a civil court into the care of the Colorado Department of Human Services because they have serious and persistent mental health conditions. Forensic clients include those who are charged with a crime and have a mental or developmental disability that prevents them from assisting in their own defense or rationally understanding the criminal court proceedings, and those who have been charged with a crime but found not guilty by reason of insanity. CFMH works across the legal system to provide evaluations, treatment and case management for these clients. Outpatient Services is the newest part of this continuum, working to support clients stepping down or being diverted from hospitals and jails, and giving them the care they need in the community. Through our core values listed below, Outpatient Services staff is committed to: Individual dignity and respect Person-centered, evidence-based care Trauma informed recovery Multidisciplinary collaboration Diversity and inclusion Strong family and community partnerships

Requirements

Seven (7) years of experience in behavioral/mental health clinical work or leadership, healthcare quality, or a similar field.
A combination of education in behavioral health, healthcare administration, quality management or related field and/or experience in behavioral/mental health clinical work or leadership, healthcare quality, or a similar field equal to seven (7) years.
Has experience working with the SMI population, and is knowledgeable about research-based SMI treatments, evidence-based effective principles for intervention, and quality auditing practices.
Full background check and reference check required.
This position requires State of Colorado residency at the time of application (unless otherwise identified in the posting), and residency within the state throughout the duration of employment in this position.
Comply with all vaccination requirements that are required by CDHS; TB testing must be completed.
Former State employees who were disciplinarily terminated or resigned in lieu of termination must: Disclose that information on the application. Explain why the prior termination or resignation should not disqualify you from the current position. Provide your employee number from your prior State employment.

Nice To Haves

Knowledge of 27-65 statute, behavioral health regulations, and/or billing and claims law and rule.
Knowledge of and experience with HIPAA and 42 CFR part 2.
Previous experience with or detailed knowledge of NCQA credentialing standards.
Previous experience with and knowledge of BHA rules.
Previous experience with clinical chart audits and documentation requirements.
Previous experience with critical incident reporting.
Relevant years of State service.

Responsibilities

Forms, leads, and maintains the OSDV Credentialing Committee, in alignment with NCQA standards, and leads program directors to support these efforts.
Oversees the work of payer enrollment for all of OSDV, ensuring staff compliance.
Leads quality and compliance audits, evaluation, and analysis to OSDV.
Presents data and relevant findings to OSDV and CFH leadership, as well as internal or external stakeholders, as directed by the Division Director.
Uses audits and program evaluations to lead clinical quality and continuous quality improvement of services provided to the Division’s clients and supports decision-making with relevant results and analyses that influence positive outcomes.
Partners with leadership to identify benchmarks for their programs to maximize effectiveness with the clients served.
Audits programs to these benchmarks and division-wide standards and provides feedback to leadership regarding problem areas in operating procedures and standards across various locations and settings.
Reviews and evaluates organizational policies, practices, structure, functions, programs, work methods, resources, and program performance and formulates solutions to increase the efficiency and effectiveness of Forensic Services.
Performs internal case audit and analysis for compliance with Consent Decree requirements, department benchmarks, and department standards and protocols.
Performs internal review to align operations and practice with BHA rule, statute, and Federal law, as applicable.
References and regards professional ethical codes and board rules governing the practice of the Outpatient Clinic treatments, and brings findings, both positive and negative, to leadership to influence practice, quality, and compliance.
Work lead for 20 FTE; guiding, coaching and mentoring subordinate staff.
Provides input into performance plans and evaluations and works in collaboration with the supervisor.
Leads and identifies areas for improvement; identifies the issues related to process improvement; and be successful in communications and recommendations for change by reviewing program documents, policy updates, and conducting chart audits.
Works closely with teams, individuals, and leaders within Outpatient Services to successfully affect change management and process improvement with current practices.
If additional data or statistical analysis is needed this position works with the information management team to ensure data is presented timely.
Operates independently in performing professional tasks.
Performs complex, cross-functional, division-wide projects or initiatives to improve processes or outcomes.
Tracks performance against established goals and makes associated recommendations to maximize performance.
New processes or objectives are reviewed with leadership.
Responsible for the ongoing efforts of the quality of processes and programs.
Collaborates and uses skills to communicate process change with staff.
Required to use diplomacy and professionalism while working with internal stakeholders representing Outpatient Services.
Collaborates with leadership to develop their program and process auditing and compliance tracking system to assure that Outpatient Services is complying with federal regulations, state statutes, policies and standards and Consent Decree, and Statutory requirements.
Analyzes and monitors the effectiveness of problematic approaches and identifies avenues to improve practices.
Program analysis is identifying deficiencies or barriers and reaching a conclusion to be presented to leaders.
In collaboration with leaders, provide formal feedback and consultation to staff in reflection of all audits and work reviews.
They may be required to participate in committees or work groups to provide program guidance and clarification, and provide input on issues that have a direct impact on the program.
Leads and has a unique level of expertise in the quality, rules, and regulations that is critical for the success of the division.
Leaders and staff recognize and seek the technical guidance and direction from this position.
Leads and assists in the facilitation and training across Outpatient Services for continuous quality improvement initiatives.
Facilitates and leads continuous improvement efforts (workshops, training, and coaching) using methods for data gathering and analysis, problem solving, project management and professional presentation skills.
Determines and implements training within Forensic Services to deliver specific training and technical assistance.
Develops instructional guidance to provide direction on consistent implementation to intra-agency departments within Forensic Services.
Has the ability to interpret and communicate results to all audiences.
Communicates and teaches process improvement methods, tools, techniques, and best practices to staff within Forensic Services and develops communication and training materials in alignment with department strategies or policies.
Creates and presents process improvement techniques and improvement results to various audiences.
May be called upon to perform tasks or undertake special assignments or projects deemed necessary by OCFMH, but not specifically referenced in the above duties.

Benefits

Strong, secure, yet flexible retirement benefits including a PERA Defined Benefit Plan or PERA Defined Contribution Plan plus 401(k) and 457 plans
Medical and dental health plans
Employer supplemented Health Savings Account
Paid life insurance
Short- and long-term disability coverage
11 paid holidays per year plus vacation and sick leave
State of Colorado Employee BenefitHub Resource Center
Employee Wellness program
Excellent work-life programs, such as flexible schedules, training and more
Remote work arrangements for eligible positions
Some positions may qualify for the Public Service Loan Forgiveness Program.