Quality Management Specialist

TX-HHSC-DSHS-DFPS•Austin, TX

7d•$4,523 - $7,254•Hybrid

About The Position

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, numerous opportunities for career advancement and more. Explore more details on the Benefits of Working at HHS webpage. As a team member, the QM Specialist plans, develops, and implements both on-site and desk reviews to assess service quality and compliance with contracts, grants, laws, regulations, policies, and procedures. The goal is to continuously enhance the quality and effectiveness of services provided. The specialist evaluates services delivered to consumers and business functions related to care management. The QM Specialist ensures effective communication of findings to stakeholders, evaluates providers’ plans for correction and improvement, and conducts follow-ups to determine if necessary improvements have been made and maintained. They produce professional, accurate communications and provide technical support and training related to compliance, quality management, and the identification of best practices. Furthermore, the QM Specialist delivers presentations and responds to inquiries from providers and the community. The role involves leading, participating in, and contributing to cross-functional teams and work-groups, as well as inter-agency and intra-agency activities. The QM Specialist collects, analyzes, and performs complex interpretations of data to assess performance, utilization, and compliance with laws, regulations, policies, procedures, contractual performance indicators, best practices, organizational risks, and service delivery gaps, ultimately making recommendations to management and providers. The candidate must reside in the Greater Austin, Texas area, or be willing to relocate to the Greater Austin, Texas area. This position may be eligible for telework. Please note, all HHS positions are subject to state and agency telework policies in addition to the discretion of the direct supervisor and business need.

Requirements

Bachelor's Degree with major course work in human service from a U.S. accredited college, university, or foreign degree determined to be equivalent by an acceptable education evaluator.
Relevant work experience in quality management or behavioral health may be substituted for education on a year-to-year basis.
Knowledge of the application of the principles of quality management for improvement of Behavioral Health services
Knowledge of state, and federal laws, agency regulations, policies, rules and requirements pertaining to the provision of BHS services in the community
Knowledge of laws and rules applicable to confidentiality and the management of protected health information
Knowledge of data systems for managing operations and making decisions
Skill in effective verbal communication and public speaking, interpretation and presentation of complex data sets and analysis
Skill in project management with complex projects that cross agencies and several lines of business
Skill in identifying problems, evaluating alternatives, and negotiating and implementing solutions to organizational and service delivery problems
Skill in advanced business and technical writing, data analysis, reporting, and interpretation of complex data sets, related to provider performance
Ability to organize and present information effectively, both orally and in writing
Ability to analyze and solve work problems affecting the operations and functions
Ability to provide information to providers regarding areas of non-compliance and less than acceptable quality in an informative non-threatening manner
Ability to plan, organize, and manage large multi-faceted projects and work in collaboration with others to manage multiple deadlines
Ability to plan, assign and manage the work of others

Nice To Haves

Knowledge of Medicaid managed care programs, policies, procedures, contracts, and service delivery mechanisms desired but not required.

Responsibilities

Plans, implements and functions as review lead or team member for on-site, desk, focused and statewide reviews to assess service quality and compliance with Behavioral Health Services contracts, grants, applicable Federal and state laws, regulations, policies, and procedures; and prepares the required reports or responses as appropriate.
Maintains positive work relationships with internal and external stakeholders.
Evaluates organizational systems, business functions and the compliance, quality and efficacy of services.
Produces a review report and evaluates corrective action plans.
Conducts follow-up to determine if improvements have been made and are maintained, and works with contract manager and program staff to recommend sanctions and penalties when applicable.
Develops and or implements policy and protocols for evaluation of business functions, service delivery and outcomes; employs quality management methods to collect, synthesize, analyze and use data in the process of facilitating continuous improvement within organizations providing Behavioral Health services.
May conduct studies and specialized research projects.
Represents Quality Management on work groups to develop standards and processes for new agency initiatives.
Provides thorough and timely communication of findings to Behavioral Health providers during reviews.
Produces professional communications including but not limited to letters, emails, technical reports, executive summaries, meeting minutes, memos, and slide show presentations.
Participates in activities such as risk assessment to determine priorities for the deployment of oversight resources; performs analysis and interpretation of data to identify trends and best practices.
Uses data and knowledge of the system to make recommendations to management and providers to improve compliance and quality.
Participates in performance measurement and identification of providers at risk due to non-compliance with the contract, organizational gaps, or delivering poor quality of services.
Provides consultation and technical assistance related to quality management, increasing compliance, and effective oversight of contracts to managers, staff, contractors, grantees, providers and stakeholders, maintaining positive work relationships with internal and external stakeholders.
Provides training for QM staff and others within the agency, providers, and members of the community, quality improvement, identification of best practices, and the development of new methods and procedures.
Identifies methods to improve processes and the efficiency of QM activities.
Participates in evaluations of inter-rater reliability to ensure accurate and consistent findings.
Plans, assigns, guides, and oversees the work of QM staff when functioning as a review or project lead, and is responsible for the efficient and effective deployment of resources within the team model.
Performs other duties as assigned.