Quality and Safety Oversight Specialist Iv
1 month ago
**Job Summary**:
In addition to the responsibilities listed below, this position is also responsible for representing assigned area on internal and external local and state behavioral health committees and professional organizations; establishing working relationships between clinical functions, administration, and members for behavioral health treatment plans and services for adult and pediatric patients; conducting barrier analysis for implementation and continuous improvement of behavioral health quality and regulatory standards; identifying and providing training on quality and regulatory standards in behavioral health; providing oversight into the behavioral health ecosystem, such as telehealth, addiction medicine, and clinical strategic goals with mínimal guidance; and analyzing and reporting initial and follow up access and barriers to timely appointments.
**Essential Responsibilities**:
- Promotes learning in others by proactively providing and/or developing information, resources, advice, and expertise with coworkers and members; builds relationships with cross-functional/external stakeholders and customers. Listens to, seeks, and addresses performance feedback; proactively provides actionable feedback to others and to managers. Pursues self-development; creates and executes plans to capitalize on strengths and develop weaknesses; leads by influencing others through technical explanations and examples and provides options and recommendations. Adopts new responsibilities; adapts to and learns from change, challenges, and feedback; demonstrates flexibility in approaches to work; champions change and helps others adapt to new tasks and processes. Facilitates team collaboration to support a business outcome.
- Facilitates quality of care complaints and the review process by: participating in grievance meetings, cases, reviews, referrals, or other mechanisms as needed and making recommendations based on available evidence and assessing if the quality of care complaint can be substantiated; providing and reviewing all documentation, records, chart reviews, staffing reviews, and the information requested; proactively coordinating with the appropriate individuals/teams to ensure the quality of care concern is referred to the right team and monitoring the process flow of investigations and claims as requested; and monitoring cases, quality care incidents, and near misses according to established protocols on an ongoing basis.
- Delivers infection prevention and control programs to improve employee and patient safety by: conducting epidemiological research as a part of prevention and surveillance, outbreak management as requested; and adhering to outbreak protocols and leading all outbreak containment efforts within the area of focus.
- Facilitates clinical quality improvement oversight risk management efforts by: assisting with the development of corrective action plan for areas of improvement identified through utilization review, clinical records audit, claim denials, patient satisfaction surveys, and auditing surveys; conducting root cause analysis, failure mode and effect analysis, and other assessments in response to significant events, near misses, and good catches in order to identify areas of improvement; assisting with escalating high-risk issues and trends to appropriate entity for resolutions; and utilizing health outcome analysis to continuously monitor oversight effectiveness.
- Delivers patient safety and satisfaction programs and initiatives by: identifying and resolving safety hazards, accidents, incidents, threats, and significant events promptly and following up accordingly; and delivering patient care and satisfaction programs which aim to improve patient flow, clinical support, patient services, and seamless transition of care.
- Develops new clinical quality improvement programs by: consulting with practicians, teams, and departments to develop guidelines, metrics, and operational definitions of quality improvement through qualitative and quantitative program evaluation, analyzing program performance, and peer/department review groups; leveraging a variety of health concepts, regulatory requirements, and change management principles to develop programs which optimize clinical quality, safety, or health outcomes; and integrating continuous learning orientation into programs to assist with oversight, development, and improvement initiatives.
- Enters and reports data from systems, procedures, and forms to improve data management programs and utilizes data from internal and external sources to monitor and evaluate quality improvement initiatives by: conducting descriptive and inferential statistical analysis for complex quality improvement evaluations; analyzing data from databases, vital statistics, hospital patient discharge data, claims, and other relevant health sources; and preparing and presenting reports (e.g., infection control research, utilization reviews, population health ne
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