Director of Quality and Compliance

4 weeks ago

Lansing, United States Judson Center Full time

Position Description

Director of Quality and Compliance

Reports To: Chief Operating Officer

Status: Full Time

FLSA Status: Exempt

Job Summary:

The Director of Quality and Compliance is responsible for overseeing and managing all aspects of quality assurance and compliance at Judson Center. This position acts as the agency Privacy Officer and is a member of the agency’s Director Team, with primary offices in the Farmington Hills administrative headquarters.

Primary Duties and Responsibilities:

The Director of Quality and Compliance develops, coordinates and oversees the organization-wide efforts to ensure that performance management, regulatory compliance and quality improvement programs are developed and implemented, using a data-driven focus that sets priorities for improvements aligned with ongoing strategic initiatives.

Establishes and maintains a continuous quality improvement and regulatory compliance monitoring and reporting system in support of the agency’s strategic initiatives and requirements from external regulatory bodies. Researches and designs appropriate organization-wide performance and quality training. Coordinates performance management and quality improvement capacity building for all levels of management and employees. Responsible for the initial and ongoing credentialing of clinical providers in alignment with Medicaid and Community Mental Health rules and regulations. Collaborates on the design of the information technology infrastructure required to support the agency’s quality improvement and compliance programs. Ensures needed data is collected on a timely basis, regular reports on progress are distributed, and recommendations are made for future improvements based on the data. Coordinates the Quality Committee by serving as the administrator. Convenes regular meetings, sets agendas, develops and analyzes performance improvement data for the council, designs and implements the necessary Quality Committee processes and systems, develops and implements an organization-wide communication plan, and develops and implements a recognition program for Improvement Teams. Ensures standardization of operations, including the development of logic models, operating manuals, work instructions and compliance audits. Works closely with senior managers in developing program policies which meet federal, state, and local government requirements. Develops and maintains overall agency compliance program and monitoring system. This includes risk management and fraud and abuse detection. Develops, implements and oversees agency-wide process of clinical

utilization management, quality auditing and case file review.

Establishes quality metrics, performance indicators, and outcome measures to assess the effectiveness of programs Ensures that quality and compliance process improvement/corrective action plans are developed and implemented to address identified issues. Supervises Senior Manager of Quality and Compliance. Ensures Regulatory Compliance by staying up-to-date with all program regulations and ensure the organization’s compliance with federal, state, and local standards and regulations. (Will assist program areas in developing and monitor corrective action plans if needed) These include requirements for licensure, accreditation, and privacy

laws (HIPAA)

Identifies potential risks related to the delivery of behavioral health services and develop mitigation strategies to address them effectively and efficiently Agency Privacy Officer designation, addressing issues such as confidentiality breaches, ORR investigations, and consumer complaints Oversees staff training compliance through reports and dashboards within the agency Learning Management System ( RELIAS) Leads the agency’s ongoing Council on Accreditation (COA) compliance and reaccreditation.

Job Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Master’s degree in human service (e.g. social work, psychology, counseling) or business field preferred. Specialized training or certification in Total Quality Management (or other formal systems of quality management) preferred. Minimum of four years mental health related experience Minimum of two years management / supervisory experience Minimum two years’ experience within a formal quality management department required. Thorough understanding of behavioral health regulations, standards of care, and ethical guidelines Strong leadership skills with the ability to inspire and motivate teams to achieve quality and compliance goals Analytical mindset with strong problem solving skills and attention to detail High degree of integrity and strong ethics Excellent communication and computer skills Ability to gather, analyze and interpret data for use in quality management and compliance planning and evaluation. Ability to develop training curricula as well as provide training to groups of staff and others. Valid Michigan Driver’s License and Insurance

Certificates, Licenses, Registrations

Master’s degree in human service (e.g. social work, psychology, counseling) or business field preferred. Formal quality management training or certification preferred.

Working Conditions

Generally, an office environment with frequent off site meetings at multiple site locations. Ability to travel and attend meetings and functions at various hours, including early morning, evenings and weekends is required. Job travel, utilizing personal vehicle with mileage reimbursement Supervises quality department staff members

This description is intended to describe the type and level of work being performed by a person assigned to this job. It is not an exhaustive list of all duties and responsibilities of a person so classified. The employee is expected to adhere to all company policies and perform other duties as assigned for the good of the consumers, the program, the department and the agency. #J-18808-Ljbffr

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