Quality Improvement Specialist

3 weeks ago

Tucson, United States Easterseals Blake Foundation Full time

Description:
The Quality Improvement Specialist works under the Senior Director of Quality Improvement and is responsible for ensuring Behavioral Health, Intellectual Developmental Disabilities, and Children and Family Services systems in the agency are contract compliant regarding, credentialing, referral tracking and utilization management on a statewide level. The Quality Specialist will be the primary contact for all quality inquires for the IDD department.

**Essential Job Duties and Responsibilities**:

- Develop and ensure Quality Improvement within the agency by facilitating the Quality Improvement Committee.
- Managing and monitoring credentialing/licensing for EBF facilities in accordance with Insurance and State requirements.
- Conduct regular audits and assessment of medical health records and implementation process.
- Performs analysis of clinical documentation to ensure support for medical necessity and level of care compliance.
- Represents EBF on the Cultural Diversity Committee
- Develops and maintains the EBF Cultural Competency and the Document Conformance Plans
- Provides education and training for all personnel as needed on quality improvement efforts, documentation, required forms, policies and procedures related to QI initiatives
- Compiles data tracking and trending information collected and reviewed into a report, provides to leadership and offers recommendations and action plans as a result of findings
- Point of contact for submissions of Quality of Care Concerns, Corrective Action Plans, Fact Findings, Non-Critical Incident Reports, Critical Incident Reports. This position will review for professionalism of writing, adequacy of content, accuracy, completeness, and clinically sound judgment. QI Specialists will provide feedback to personnel if corrections are requested.
- QI Department interacts will all departments within the agency for quality improvement efforts.
- Contributes to Quality Improvement Annual Plan and conducts Quarterly Audits in adherence to the QI Plan
- Contributes to quarterly Board reports in conjunction with the QI team
- Conducts investigations prompted by critical incident reports, insurance plans, grievances, complaints, and other sources of reporting
- Responsible for logging and tracking Incident, Accident and Death Reports
- Respond to medical record requests from Insurance Plans
- Monitor HCBS compliance with IDD
- Collaborates with the Director of Compliance for subpoena sign-off and coordination
- Any other duties as assigned.

**Requirements**:

- Bachelor's degree in a related field or minimum of four years' experience in behavioral health and/or working with individuals with Intellectual and Development Disabilities (IDD).
- Extensive knowledge of managed care systems, AHCCCS/Title XIX medical assistance screening, and insurance policies and practices.
- Operational experience in continuous quality improvement, conducting root cause analysis, process improvement, redesign, performance measurement, health information technology, evidence-based practice guidelines and facilitation, and knowledge of Integrated Behavioral Health Care, IDD, Pediatric and Adult Behavioral Health.
- Must be at least 21 years of age and able to obtain a Level One Fingerprint Clearance Card.
- Valid Arizona driver's license and the willingness to use personal vehicle in the course of employment.
- Must meet minimum requirements of agency insurance carrier.
- Must be able to meet training and agency compliance requirements for the position.

**Easterseals Blake Foundation is an EEO/AA/Vet/Disabled Employer

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