Quality & Compliance Specialist - Crisis

DETROIT WAYNE Integrated HEALTH Network•Detroit, MI

2d•Hybrid

About The Position

Under the general supervision of the Director of Crisis Quality and Compliance, the Quality and Compliance Specialist is responsible for performing all duties associated with evaluating and monitoring the Quality of care for Crisis Care Services.

Requirements

Knowledge of DWIHN policies, procedures, and practices.
Knowledge of the principles of quality improvement.
Knowledge of Critical/Sentinel Event policies and procedures.
Knowledge of Quality Assurance.
Knowledge of accreditation and certification standards related to the provision of mental health, developmental disability and substance use disorder services.
Knowledge of the DWIHN provider network.
Knowledge of medical and behavioral health practices and terminology.
Knowledge of compliance standards.
Knowledge of the Medicaid screening process.
Knowledge of MDHHS policies, rules, regulations and procedures.
Knowledge of health care fraud and abuse laws, including the False Claims Act, Stark Laws, and the Anti-Kickback Statute, including the associated penalties.
Knowledge of health care law, regulations and standards.
Knowledge of governmental compliance regulations.
Knowledge of contracting policies and procedures.
Knowledge of Quality Management and Improvement principles and practices.
Knowledge of HIPPA Compliance.
Corrective Action skills.
Computer skills.
Time management skills.
Organizational skills.
Critical thinking skills.
Teamwork skills.
Conflict Resolution skills.
Decision Making skills.
Project Management skills.
Assessment skills.
Report writing skills.
Communication skills.
Multitasking skills.
Analytical skills
Ability to communicate orally.
Ability to communicate in writing.
Ability to work effectively with others.
Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.
Judgment/Reasoning ability.
A Bachelor’s degree from a recognized college or university in Human Services, Social Services, Nursing, Public Health, Public Administration, Healthcare Administration, Health Management, Epidemiology, or a related field is required.
Four (4) years of professional experience in a behavioral healthcare or mental health setting, including two (2) years of professional experience in Quality Management and Accreditation.
Four (4) years of professional experience in a behavioral healthcare or mental health setting, including two (2) years of professional experience in Statistical analysis of health care data, metrics, systems, and standards.
A valid State of Michigan Driver’s License with a safe and acceptable driving record.

Nice To Haves

A Master’s degree in one of the fields listed above is preferred.
Certified Professional in Healthcare Quality certification preferred.

Responsibilities

Ensures compliance with all applicable State and Federal requirements and promotes safety, quality, and effective service delivery.
Oversees data collection, monitoring, analysis, and reporting systems in compliance with the PIHP and State requirements.
Interprets, formulates and maintains continuous quality improvement (CQI) and assurance programs and performs quality assurance reviews designed to ensure quality services consistent with national industry standards, compliance and state regulations.
Creates performance improvement projects based on quality analysis.
Prepares quality documentation and reports by collecting, analyzing, and summarizing information and trends, including failed processes, stability assessments, corrective actions, and validations.
Reviews quality outputs for compliance (internally and externally).
Assures that clinic policies meet PIHP, State, Federal, Joint Commission, and all other accreditation standards.
Reviews agency and State policies and ensures consistency in implementation.
Prepares regular reporting based on organization and certification-related requirements.
Interprets, applies, and recommends changes to organizational policies and procedures.
Works with department supervisors to identify specific quality program objectives or problems, recommends system improvements, and monitors the approved changes.
Conducts thorough internal investigations, gathering and analyzing relevant data, interviewing key stakeholders, and ensuring compliance with company policies and legal regulations to identify potential issues and recommend corrective actions.
Recommends practices, productivity, quality, and customer-service standards.
Completes incident reports, critical and sentinel event reporting, root cause analysis and improvement plans as applicable.
Prepares the clinic and programs for accreditation, such as the Joint Commission, and assists in leading site reviews.
Drafts written reports and presentations related to evaluation processes and findings.
Aggregates and presents performance/evaluation data to leadership and the care team on a monthly or quarterly basis.
Develops and trains staff on protocols, procedures, policies, and compliance standards.
Works with a cross-functional team to define and develop analysis plans, ensure data quality standards, and create ready results.
Utilizes a systematic method to collect and analyze data and identify gaps and areas of strength.
Performs related duties and responsibilities as assigned.