Quality Management Specialist

TX-HHSC-DSHS-DFPS • Houston, TX

9d • 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.

Program Specialist V works under the general direction of the Quality Managment (QM) Director or designee with considerable latitude for use of initiative and independent judgment. Specialist functions as part of a team of staff specifically designated to work on oversight and management of the Medicaid State Plan Amendment, 1915(i) program, called Home and Community-Based Services - Adult Mental Health (HCBS-AMH) for persons with serious mental illness. The HCBS-AMH program provides an array of services appropriate to each person's needs to enable them to live and experience a successful tenure in their community. Services are designed to support long-term recovery from mental illness and to divert placement in correctional facilities, hospital emergency departments and psychiatric hospitalization. Specialist will perform advanced (senior-level) consultative services and technical assistance work that involves working with community-based providers. Duties may include but are not limited to: develop policies and procedures, provide technical assistance and monitor provider compliance, monitor client and provider complaints, including critical incidents. Coordinate and completes quality management activities including collecting and reporting performance measures, monitoring utilization patterns of clients and providers, and investigating clinical quality issues and completes all required reports and related documentation. Specialist will work closely with the Texas Health and Human Services (HHSC) Quality Management and Decision Support Units, and Centers for Medicare and Medicaid Services (CMS) to ensure compliance with the waiver and contract requirements, develop and implement program goals and objectives, and ensure project course corrections when needed. Works closely with the mental health providers contracted to provide waiver program services to resolve problems and discuss program effectiveness.

Requirements

• Graduation from an accredited four-year college or university with major coursework in health services, business administration, human services, social work or a related field is required.
• At least 2 years experience working within Medicaid or similar program(s).
• Knowledge of quality assurance and monitoring processes, best practice and continuousquality improvement.
• Familiarity with quality management activities and strategies.
• Knowledge of federal reporting guidelines.
• Knowledge of waivers and/or state plan amendments.
• Knowledge of program planning and implementation.
• Knowledge of public mental health systems.
• Knowledge of mental health issues and treatment modalities.
• Knowledge of Medicaid services.
• Ability to function effectively in a fast paced environment, to oversee/manage multiplecomplex projects simultaneously, and to meet deadlines.
• Ability to exercise initiative and independent judgment.
• Ability to analyze data for completeness and accuracy and to utilize data to identify issues,trends, and other programmatic needs.
• Ability to interact with multiple, diverse stakeholder groups.
• Ability to effectively communicate orally and in writing.

Nice To Haves

• Licensure Requirements: Licensed Practitioner of the Healing Arts (LPHA) in accordance withTexas Administrative Code §412.303 MENTAL HEALTH COMMUNITY SERVICESSTANDARDS, Subchapter G preferred, not required.
• Experience in quality management is preferred.
• Experience operating and overseeing youth programs or mental health programs.

Responsibilities

• Provides complex consultative services and technical assistance to plan, implement, and monitor program services. Works closely with community-based providers and local mental health authorities.
• Develops policies and procedures related to implementation and monitoring of r program services. Ensures that local mental health authorities and other community-based providers receive training on new policies and procedures, and that periodic monitoring takes place.
• Conducts and coordinates desk and onsite reviews to determine compliance with program requirements, laws, regulations, policies, and procedures. Analyzes reviews of program services and develops corrective action plans to improve effectiveness, if needed. Communicates those findings, orally and in writing, to a wide variety of audiences, including HHSC and CMS.
• Ensures that there is continuous quality monitoring program in place to ensure that identified problems are acted upon and resolved promptly. Determines when course corrections are required when program or program provider is not achieving goals or objectives.
• Collects, organizes, analyzes, and prepares material in response to requests for information from internal and external stakeholders. Synthesizes complex information for presentation to a wide variety of groups, orally and in writing. These groups consist of HHSC leadership, CMS and local stakeholders.
• Determines trends and resolves operational problems, within HHSC and within LMHAs and/or provider organizations. These consist of service delivery issues, data collection/submission issues, data entry issues, data analysis issues, invoicing processing issues (by providers), invoice processing issues (by HHSC).
• Participates in State Plan Amendment renewal and amendment and reporting processes.
• Ability to collaborate effectively with behavioral health team and providers. Performs related work as assigned

Benefits

• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level