Job Description

POSITION SUMMARY:

The Quality Assurance Supervisor is responsible for ongoing monitoring of operational practices, quality improvement activities and compliance with applicable WISE contractual requirements as well as those provided by the Centers for Medicare & Medicaid Services (CMS). ABH is the administrative services organization supporting the back-office administration and management of this program. The WISE program seeks to move individuals with mental health problems from nursing homes into the community, or assist individuals already in the community to remain there. The program arranges for community supports and on-going services. ABH’s roles include: (1) to identify, credential, train and contract providers; (2) assist in plan implementation; (3) pay claims; (4) collect and report data; and (5) manage quality improvement. The Quality Assurance Supervisor will work closely with the ABH Reporting Department in the development of specialized reports and data collection tools needed for evaluating the quantity and quality of the operational practices, impact of quality improvement activities and establishing information links with other data sources for the WISE Program components. This position will represent ABH and its services in a positive and professional manner and adhere to ABH’s best practices, guidelines, policies and procedures as established, promoting ABH as a leader in behavioral healthcare in all interactions and work.

DUTIES AND RESPONSIBILITIES:

• Documents, analyzes, and prepares regular reports on operational practices, quality management indictors: service utilization trends; sentinel events; seclusion & restraints use; review completeness; and complaints & grievances;
• Develops and maintains various databases and measurement mechanisms for the collection, analysis, and reporting of quality improvement initiatives & activities;
• Analyzes outcomes of quality improvement initiatives & activities using sound methodologies, including statistical reliability tests;
• Prepares comprehensive analysis reports on service utilization trends and quality improvement initiatives & activities (narrative summaries and visual presentations, e.g. MS Excel charts, graphs, flowcharts) in a timely manner;
• Conducts regular audits and prepares monthly and quarterly reports regarding compliance with contract performance standards;
• Works collaboratively with ABH & WISE management staff to develop and report on provider profiles, provider access analyses, and healthcare disparities among disadvantaged populations;
• Participates in the development and administration of provider and consumer satisfaction surveys, including database design, data collection, and outcomes reporting;
• Oversee the claim process including the review of all appeals. When appropriate responds, in writing to administrative appeals in a timely manner. Tracks, trends and reports on appeal issues and responsiveness over time;
• Assists with preparation/updating of training materials, policies & procedures, workflow documents, and project plans;
• Coordinates tracking of recipient feedback from Community Support Staff, site visits (and other sources) and provider feedback from Community Support staff;
• Attend and participate in monthly Quality Management meetings and any internal QI-related staff meetings;
• Attends staff, supervision, training, and other meetings as requested;
• Maintains confidentiality of all client protected health information and adheres to all HIPPA and 42 CFR 42 related policies and procedures;
• Performs other tasks/responsibilities as required to support the business operations;
• Demonstrates ethical behavior and cultural sensitivity in all activities involving individuals of diverse backgrounds.

SUPERVISORY DUTIES AND RESPONSIBLITIES:

Responsible for the supervision/management of staff assigned. This includes; but is not limited to establishing and maintaining a working environment conducive to positive morale and teamwork; recruit and hire qualified employees; provide orientation and on-the-job training for staff. Establish short and long term goals that are both measurable and obtainable to meet contract requirements and ensure that these expectations are clearly communicated and understood by all direct and indirect reports. Review and approve all applicable timesheets. Oversee the daily responsibilities of direct reports to ensure that ABH® policies and procedures are being followed and the program/department goals are being met. Provide year-round feedback to employees, counseling, coaching, and training resources and support as necessary. Refer performance concerns/issues to next level Managers & Human Resources Department for advice, next steps and appropriate action. Complete timely staff performance evaluations outlining clearly defining goals/expectations, secure applicable signatures/approvals and process paperwork.

EDUCATION AND EXPERIENCE REQUIREMENTS:

 

• Bachelor's Degree in health sciences or related field required;
• 2+ years experience in HMO/health insurance or Home care service provision required.

KNOWLEDGE/SKILLS/ABILITIES:

• Ability to work under the direction of a supervisor as well as the ability to work well independently and in collaboration with other staff members to meet assignment deadlines;
• Demonstrated ability to manage various data collection methodologies, information analyses, and produce clear report presentations;
• Must be flexible in order to respond quickly and positively to shifting demands;
• Strong attention to detail; ability to work on multiple tasks and meet deadlines;
• Excellent PC skills with demonstrated experience using Microsoft Office Package (MS Word, Excel, Power Point, Access, Outlook); internet;
• Strong written and verbal communication skills required.

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