Quality Improvement and Compliance Specialist I

2 months ago

Tucson, United States Casa de los Ninos Full time
Job DescriptionJob Description

Who We Are

Casa de los Niños is one of the most established and well respected non-profit organizations in Tucson. We have been helping kids and healing families since 1973. Our services include parent education classes, Foster Care, Parents As Teachers, Behavioral Health, and Nurse-Family Partnership Program


Job Summary:

The Quality Improvement & Compliance Specialist will assist with all quality improvement and compliance activities throughout all programs in the organization. The position will help monitor compliance standards for COA, state and OLR licensing, DCS, DES, AOC, AHCCCS, and various health plans. In addition, conducts internal audits of patient/client files and programs, assists with preparation for internal and external audits, also processes incident report reviews and any Quality-of-Care Concerns.


Essential Duties:

  • Reviews patient/client charts for all programs and makes quality and compliance recommendations to the department based on any deficiencies noted in the record.
  • Reviews and analyzes data to ensure optimal documentation and services standards.
  • Coordinates/Communicates with providers and other parties to facilitate optimal care/treatment.
  • Conducts medical record audits and help facilitate process improvement activities to ensure compliance with industry standards and guidelines
  • Collect and manage patient information from Casa de los Ninos personnel to complete medical/client records.
  • Maintain patient/client files and records according to established standards.
  • Assists with training and implementation of HIPAA standards.
  • Responsible for organization-wide safeguards for HIPAA compliance and Protected Health Information
  • Monitors and evaluates the quality-of-service provision and helps ensure compliance with regulatory bodies.
  • Reviews, tracks and trend incident reports and assists with related process improvement activities.
  • Assists with root cause analysis, development of corrective action plans, and monitoring progress toward goals.
  • Identifying and assessing areas of significant business risk.
  • Managing and reporting compliance breaches and exposures, conducting ad hoc investigations into identified or reported risks, as necessary.
  • Assists with preparing reports, equipment, and credentials for external auditors.
  • Assists all programs/departments to create and monitor KPIs and performance outcomes
  • Process credentialing and re-credentialing applications and certifications.
  • Screen practitioner's applications and supporting documentation to ascertain eligibility
  • Monitor and track utilization review outcomes and trends, identify areas for improvement, and make recommendations for process enhancements.

Required Education/Experience/Skills/Abilities:

  • Bachelor's Degree on behavioral health, health care administration or business-related field preferred.
  • Two (2) years of experience in health care or quality management/compliance.
  • Proof of COVID immunization.
  • Excellent working knowledge of Microsoft Office applications and EHR.
  • Must be able to meet training and organization requirements for the position.
  • Must foster an environment that is solution-focused, dedicated, and compassionate to support the organization's mission, values, and strategic direction
  • Must exhibit a demonstrated commitment to diversity and inclusion, valuing diverse perspectives and encouraging contributions by all team members.
  • Must possess or be able to qualify for and maintain a valid Arizona department of public safety level one fingerprint clearance card.
  • Must possess and maintain a valid Arizona driver's license and be insurable under the organization's automobile policy.

Our Mission

Casa de los Niños promotes child well-being and family stability in our community. We place top priority on hiring and growing a team of knowledgeable, passionate, creative, and diverse individuals who have a strong desire to empower children and families within our community. More information about us and our current job openings is available at www.casadelosninos.org. Casa de los Niños is an equal opportunity employer and does not discriminate against otherwise qualified applicants on the basis of race, color, creed, religion, ancestry, age, sex, marital status, national origin, disability or handicap, veteran status, gender identity, gender(sex), sexual orientation, or familial status.


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