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Quality Assurance Specialist
3 months ago
Job Summary:
CASES is seeking a dedicated and experienced Quality Assurance Specialist to join our team at CASES. The successful candidate will play a vital role in ensuring the highest standards of care and compliance with various regulatory agencies, including the New York State Office of Mental Health (OMH), NYC Department of Health and Mental Health (DOHMH), and others such as NYS Office of the Medicaid Inspector General (OMIG), Health Insurance Portability and Accountability Act (HIPAA), 42 CFR Part 2, Confidentiality for Substance Use Disorder Treatment, NYS Justice Center for the Protection of People with Special Needs, Health Home Care Management, and Medicaid Managed Care Organizations (MCO).
The ideal Quality Assurance Specialist candidate will have a strong background in the field, with expertise in areas such as assessment, treatment planning, diagnosis, and documentation. They will be well-versed in the standards of care and regulations set by relevant agencies and possess a deep understanding of person-centered care.
Additionally, the quality assurance specialist will have experience working with individuals facing complex challenges, including serious mental illness, co-occurring substance use disorders, trauma, and involvement with the criminal legal system. They will also be knowledgeable about the treatment of co-occurring medical conditions and the importance of incident reporting.
If you have the necessary skills, experience, and passion for making a positive impact in the lives of individuals with mental health challenges, we encourage you to apply for this rewarding opportunity at CASES. Together, we can make a meaningful difference in our community.
Salary: The salary for the role is $65,000 per year.
Shift Hours: This position is full-time Monday-Friday 9am-5pm.
Location Address: 151 Lawrence Street 4th Floor Brooklyn, NY 11201.
Workplace Flexibility : This position is remote but at times will be expected to work in person at CASES to deliver staff trainings and to participate in meetings. When working in person quality assurance specialist would work at one of our offices in NYC.
What You Will Be Doing:
- Quality Assurance Specialist will conduct internal chart review and audits to confirm client records meet standards of care, licensing, medical necessity, State and MCO Medicaid regulations.
- Quality Assurance Specialist will complete timely utilization review (UR) of client documentation for medical necessity admission and continuing stay, and discharge reasons; develop recommendations shared with managers and monitor how UR decisions are implemented by the treatment team.
- Coordinate and support the incident reporting and review program according to NYS Part 524 regulations, promoting effective staff onboarding and training, engaging and helpful incident review meetings, timely minutes, and follow-up procedures and practices. Ensure incidents are documented, investigated, and appropriately reviewed.
- Quality Assurance Specialist will support risk management practices for clients with high vulnerability for poor outcomes related to suicide, violence, and medical problems working collaboratively with treatment program managers on quality of care and evidence-based treatment services.
- Conduct continuous quality improvement (CQI) initiatives with treatment program managers to improve program performance and client outcomes.
- Monitor and ensure treatment programs comply with client privacy and release of confidential protected healthcare information, including HIPAA and 42 CFR Part 2 Confidentiality for Substance Use Disorder Treatment.
- Quality Assurance Specialist will conduct real-time review and approval of documentation that will be shared with criminal legal system stakeholders about client status and progress in treatment.
- Develop and deliver training programs and staff coaching on policies and procedures, documentation, incident reporting, and standards of care to meet the needs of new hires and each treatment program, in compliance with local, state, and federal regulations.
- Demonstrate a commitment to diversity, equity, and inclusion through continuous development and modeling inclusive behaviors.
What We Are Looking For:
- LMSW, LMHC with at least 1 year of quality improvement and compliance experience with NYS licensed treatment programs.
- Maintain a high degree of accuracy along with attention to detail.
- Prioritize assignments and meet stringent deadlines.
- Ability to provide strengths-based constructive feedback, deal with sensitive issues, and maintain confidentiality, all with a focus on improved quality.
- Value diversity, equity, and belonging and contribute to an inclusive work environment.
- Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, and SharePoint).
- Excellent communication, verbal, written, presentation and interpersonal skills.
Benefits:
CASES cares about employee wellbeing, and we offer a comprehensive benefits package to support you and your family, including:
- Medical
- Dental
- Vision
- Vacation and Paid Time Off – starting at 25 days
- 12 Paid Holidays per year.
- Flexible Work Arrangements whenever possible. May be Fully onsite, Hybrid, Flexible, or Fully Remote view individual job descriptions for specific work place flexibility details.
- Retirement 403(b) Competitive matching up to 6%.
- Employee Referral Program
Although we would love to learn about the skills of every candidate, only selected candidates that are selected will receive a response. We encourage you to apply for any position(s) you feel you are qualified for.
