Job Description
Summary
Under limited supervision, evaluates and recommends improvements for the quality of behavioral health services provided by CODAC and its subcontracted service providers.
This position also oversees all on-going activities related to the development, implementation, maintenance of, and adherence to the agency’s policies and procedures, covering the privacy of, and access to, patient health information in compliance with federal and state laws and healthcare organizations’ information privacy practices.
Essential Duties and Responsibilities
- Supervise QM Department, QM Analysts and develop QM goals and monitor progress.
- Ensure the department is focused on performance improvement utilizing CODAC’s continuous quality management process and other quality management principles.
- Monitor compliance, share results, identify gaps, and assist with process improvement.
- Review, evaluate, implement, and submit annual QM Plan, Workplan, and QM Evaluation to ensure annual agency improvement process is relevant.
- Monitor and evaluate the overall quality of behavioral health services provided by CODAC.
- Understand and assist the organization in complying with RBHA contracts, state legislation, CARF accreditation standards, AHCCCS, ADHS / DBHS, DEA, DES and other funding / regulatory requirements and report results to leadership, applicable sites, and internal committees.
- Provide trending reports to Leadership and various committee meetings including recommended actions for improvement.
- Responsible for oversight of agency facilities’ licensure. Ensure completion of new applications, renewals, and monitors / communicates changes.
- Coordinate / complete site reviews, including residential and other sites as needed : assure compliance with licensing, accreditation, and other contracting requirements.
- Coordinate internal and external audits, perform periodic chart reviews, quality improvement monitors, focus reviews and prepare reports of findings and recommendations for corrective action implementation.
- Ensure compliance with documentation requirements, including organizing regular documentation and billing and coding reviews and addressing any concerns including gaps in training.
- Track, monitor and implement improvement actions for specialized projects and evaluate the success of such actions.
- Serve as QM liaison to departments, committees, and work groups within CODAC.
- Assist with agency-wide preparation process in maintaining national accreditation status.
- Assist in the development and maintenance of systems and forms to ensure compliance and quality of clinical services.
- Investigate internally reported critical incidents, Notice of Concerns, and Quality of Care Concerns and prepare reports / responses of findings.
- Monitor and facilitate the responses for Grievances and Appeals, notice of actions, other legal / contractual requirements including the review of SMI determination assessment and submissions.
- Coordinate the review of Sentinel Events with QM team, treatment team, leadership, and the Sentinel Events Committee.
- Review, respond to, cooperate with, and develop plans of correction for external agencies regarding inquiries involving serious incidents including mortalities, member services, complaints, and HIPAA violations.
- Provide quality management and coding, billing and documentation training and technical assistance to agency staff.
- Ensure development and maintenance of agency policies and procedures; assist in writing, reviewing, and updating policies and procedures, as necessary.
- Perform other related activities based upon growth of the organization and changes.
Skills / Requirements
Education :
Master's degree in a behavioral health field AND experience in behavioral health or quality management
Experience :
- 3 years’ experience implementing, coordinating, and managing activities to achieve program objectives; AND
- 2 years supervisory experience.
- Experience working with the use of electronic health / medical records, NextGen system, preferred.
Certifications :
- Certified Professional Coder, required
- CPHQ (Certified Professional In Healthcare Quality), preferred
Licensure :
Licensed by the Arizona Board of Behavioral Health, preferred
Additional Requirements :
- Valid Arizona Driver’s license, proof of current insurance and willingness to use personal vehicle.
- Clean Motor Vehicle Record - no more than 2 moving violations or a license suspension in past 3 years.
Skills :
- Extensive knowledge of Systems of Care.
- Extensive knowledge of community resources.
- Extensive knowledge of behavioral health challenges which include knowledge of the impacts of mental illness, physical / medical conditions, domestic violence, and the dynamics of addictive behavior.
- Intermediate to advanced computer skills using MS Office products, Word, Excel, Access, etc., importing / exporting data to / from applications.
- Knowledge of advanced statistical methodologies.
- Ability to communicate effectively both orally and in writing.
- Ability to interact effectively with other service providers.
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