Specialist-QM

NORTH TEXAS BEHAVIORAL HEALTH AUTHORITY•Dallas, TX

1d•Hybrid

About The Position

North Texas Behavioral Health Authority (NTBHA), based in Dallas, is responsible for developing a collaborative system of care for children, adolescents, and adults with severe mental illness and other serious emotional disturbances, as well as those experiencing a substance use disorder. This position's actions and work must align with NTBHA values and goals, regulations, and policies and procedures, and meet all documentation standards and regulatory requirements. The Quality Management Department is responsible for carrying out Quality Management functions as required per our state contract as a Local Behavioral Health Authority over Dallas, Ellis, Hunt, Kaufman, Navarro, and Rockwall Counties. Functions include but are not limited to quality assurance and improvement activities, conducting periodic and annual audits, addressing complaints and Quality of Care issues with providers, and monitoring for compliance of State Mandates. QM functions are carried out consistently and per NTBHA’s policies and procedures. This position reports to the Quality Management Manager. Travel is required as part of this role’s duties. Travel can vary from 20% to 100% per day. This would include all counties within NTBHA Catchment area (Dallas, Ellis, Hunt, Kaufman, Navarro & Rockwall Counties). This role may be required to use a fleet vehicle and/or a personal vehicle for business needs. This may include, but not limited to field & home visits, offsite meetings, co-located sites and/or pick up items for business needs, etc. If your program requires transport of individuals, this would only be allowed with a company vehicle and approval from management.

Requirements

Master’s Degree in the human services or related field.
Licensed Practitioner of the Healing Arts (LPHA) preferred, in the state of Texas, RN, LPC, LCSW or LMFT.
Must have three years or more experience in psychiatric and/or substance abuse health care settings and/or in a managed healthcare setting and/or Quality Management Department.
Working knowledge of rules, regulations and other guidelines of Texas Resilience and Recovery (TRR) program.
Familiarity with the Texas Administrative Code (TAC).
Possess and maintains a valid driver’s license.
Pass and maintain a clear background record as required for healthcare organization under state and federal contracts.
Possess integrity and compliance – can be relied upon to act ethically.
Ability to work in a fast-paced work environment.
Be cognizant of the diverse nature of the populations we serve and the individuals we work with, and reflect inclusiveness in our behavior, communications, and in the programs and processes we have developed.
Ability to learn quickly and adjust work assignments in response to system changes.
Ability to recognize problems and identify and facilitate solutions.
Detail and accuracy oriented.
Exercise good judgement and maintain confidentiality and handle sensitive information with utmost discretion.
All positions at NTBHA require the protection of the privacy and security of personal health information as defined in state and federal law.
Constantly meet established productivity, schedule adherence, and quality standards while maintaining good attendance.
Communicate effectively and use effective interpersonal skills.
Effectively work in a multi-task environment, prioritizing tasks properly, and completing tasks/projects in a timely manner.
Proficient in the development of professional oral and written communications.

Nice To Haves

Licensed Practitioner of the Healing Arts (LPHA) preferred, in the state of Texas, RN, LPC, LCSW or LMFT.

Responsibilities

Collaborates with UM/CM staff to identify and resolve quality of care concerns internally or externally with providers that arise during routine performance of their responsibilities.
Oversees and performs investigations of all levels of complaints and quality of care concerns submitted by consumers, families, providers, and other stakeholders.
Acts as a liaison between consumers and their treatment providers to resolve concerns.
Works closely with providers to resolve issues and to improve quality care and satisfactory customer service.
Researches and reviews clinical information/treatment records and reports outcomes for committee review.
Reviews clinical assessments and other treatment record information to determine if there is a deviation from the standard of care for the level of care reviewed.
Requests provider corrective action plans and monitors compliance related to quality of care concerns.
Provides committee follow-up and tracking to ensure issues are addressed and coordinates with Clinical team and Medical Director related to clinical processes.
Conducts provider clinical audits and internal QA/QM assessments to ensure compliance with organizational policies and mandated HHSC requirements.
Helps develop, participate, and monitor Quality Improvement projects per our State Contract and internal initiatives.
Create, analyze, prepare, and maintain records, files, databases, documents, reports, and correspondence.
Assists in compiling monthly, quarterly, and annual reports of internal and contracted provider monitoring and evaluation activities as required.
Assists in developing program and/or contract specific monitoring tools initially and revises the tools at least annually or more frequently, as needed.
Serves as liaison and resource to contracted provider staff regarding anything related to QM functions and/or program information.
Provides information timely to relevant NTBHA staff or provider staff regarding any identified urgent concerns.
Ability to analyze relevant data for significant trends and stays current on best practices for behavioral health services and related health and social services as they affect NTBHA and our contracted providers.
Skilled at research, data analysis and researching adequate conclusions.
Make effective recommendations for plans of action and assist in implementing them.
Resourceful in finding effective solutions or alternatives.
Constructively and efficiently work with other professionals and staff, community representatives, persons with disabilities, and family members.
Duties and projects may be assigned or changed to meet business needs.
Must be able to work on and have knowledge of a PC (personal computer).
Advanced Microsoft Office Suite skills - Outlook, Word, Excel, PowerPoint, etc., with an ability to become familiar with company-specific programs and software.
Duties and projects may be assigned or changed to meet business needs.