Quality Management Specialist

Exceptional Family Resources•Syracuse, NY

1d•Onsite

About The Position

Indera is looking for a Quality Management Specialist to join their team. This role focuses on ensuring compliance and quality within the NHTD/TBI waiver programs across an 8-county region. The specialist will be responsible for incident reporting, quality monitoring, reviewing service plans and provider applications, and submitting reports to the Department of Health (DOH). The position requires a high level of professionalism, ethical conduct, and confidentiality, while also maintaining a safe work environment.

Requirements

Proficient computer skills, especially with Microsoft Suite.
Demonstrated ability to learn new computer systems and software.
Excellent interpersonal skills (in person and phone).
Demonstrated professional verbal and written communication skills.
Ability to gather important information and present it to various audiences.
Strong organizational skills with physical and electronic records and data.
Working knowledge of community-based resources and services.
Working knowledge of the operation of 1915 (c) waivers.
Working knowledge of issues concerning individuals with disabilities and seniors.
Working knowledge of benefits provided by Medicaid, Medicare and/or other third party payers.
Clean Driver License.
Inspected, insured, reliable transportation.
Experience in person-centered planning and team building.
Ability to review and analyze records, reports and surveys to determine trends.
Proven ability to assist program development.
Possess a Bachelor’s degree in health or human services or a related field and two years of combined satisfactory professional experience in working with individuals with disabilities and/or seniors.
OR Be a Registered Professional Nurse and have one year of combined satisfactory professional experience working with individuals with disabilities and/or seniors, including in a managerial capacity.
OR Possess an associate degree and five years of combined satisfactory experience working with individuals with disabilities and/or seniors, including in a managerial capacity.

Responsibilities

Assist with the Serious Reportable Incident (SRI) process, ensuring compliance and timely submission of documentation.
Track SRI information to identify regional trends and emerging issues.
Perform internal DOH RRDC file reviews to confirm adherence to authorization procedures and waiver requirements.
Conduct waiver provider service audits across an 8-county region.
Analyze trends to identify problematic areas and develop supportive activities/trainings.
Develop, implement, and ensure completion of corrective action plans.
Ensure waiver participants complete annual satisfaction surveys.
Assist in reviewing Service Plans to ensure accuracy and meet participant health and welfare needs.
Assist with the provider enrollment process and submission to DOH.
Review quarterly and annual SRI reports from waiver providers.
Submit monthly numbers reports, quarterly SRI reports, and quarterly complaint reports to DOH waiver staff.
Make recommendations to the Lead RRDS/DOH for improvements to NHTD/TBI waiver policies and procedures.
Uphold codes of conduct, ethics, and company policies.
Exercise sound judgment and maintain confidentiality of protected health information.
Perform other duties as assigned.
Maintain a safe work environment.