Job Title: Total Quality Improvement Coordinator

Department: Compliance /Quality Improvement

Immediate Supervisor Title: Chief Compliance Officer (CCO)

Job Supervisory Responsibilities: Intermediate

General Summary: An exempt position responsible for directing and coordinating quality management efforts including development, implementation, education, data collection, and analysis.

Essential Job Responsibilities:

• Help the Quality Improvement Director (QID) and/or the corporate Chief Compliance Officer (CCO) to plan, design, implement, and maintain a comprehensive psychotherapeutic, clinical, and medical necessity practice continuous quality improvement (CQI) program including utilization management and risk management.
• Assist in educating new staff about QI systems and requirements including providing training related to Quality Improvement and Assurance processes and procedures.
• Meet with internal and external audiences to identify and problem-solve QI issues.
• Monitor everyday operations to ensure compliance with internal and external QI standards. Review records and other documentation to ensure service excellence.
• Helps to prepare annual QI report.
• Coordinate the effort to gather data and prepare reports to meet internal and external standards, and regulatory/accrediting guidelines, including client/consumer satisfaction data.
• Evaluate variance and other data to identify QI opportunities and risk management issues.
• Monitor utilization and service quality through medical necessity review, HEDIS quality measures, payer/provider/client satisfaction surveys, grievances/complaints resolution, and investigations.
• Follow through on complaints including identification of corrective actions needed. Provide reports on results.
• Manage a team of auditor(s) and incident coordinator/investigator(s) under the oversight of the QID and or the CCO. Prepare, record keep, track, and submit incident report(s) internally, as well as externally to the regulatory agencies when need imposes. Perform grievance/complaint intakes to consumers/clients.
• Provide EMR support and guidance to staff

EDUCATION
Minimum of a Bachelor’s degree in Social Work or any health-related field or equivalent

EXPERIENCE
Minimum four years of experience in behavioral and mental health with a minimum of three years of experience in quality management/leadership, preferably in a Core Services Agency (CSA) setting.

OTHER REQUIREMENTS: Current CPR certificate. NCQA certification preferred.

PERFORMANCE REQUIREMENTS

KNOWLEDGE

1. Knowledge of CQI principles, practices, methods, and tools.
2. Knowledge of computer applications related to QI, including spreadsheets.
3. Knowledge of medical records and clinical care processes.
4. Knowledge of medical necessity standards and DBH guidelines

SKILLS

1. Skill in effective education and facilitation of CQI efforts in the behavioral and mental health field
2. Skill in the application of analytical methods and statistical software by developing appropriate reports.
3. Skill in conducting QI checks of medical necessity documentation/records and other clinical documentation including performing client satisfaction surveys.

ABILITIES

1. Ability to educate staff in both verbal and written form about QI in formal and informal settings.
2. Ability to interact effectively with healthcare team members.
3. Ability to analyze QI data and identify trends and corrective actions.

Equipment Operated: Standard office equipment including computer hardware and software.

Work Environment: Primarily office and classroom settings.