Utilization/ Compliance QA/ QI Specialist

JOB SUMMARY: This position is an experienced utilization and quality assurance specialist to support the development of a respite program with a commitment to thorough monitoring of program utilization and quality. This Specialist is an exceptionally organized, methodical professional with the experience necessary to monitor accuracy, compliance, and safety. The Utilization Management and QA/QI program that not only safeguards the quality of our services, but also fosters a “quality culture,” in which all employees become actively engaged in guaranteeing quality services. Participates in organization’s continuous quality improvement efforts.

ESSENTIAL FUNCTIONS:

1. Provides monitoring and support of programmatic goals under supervision of the Support Services Manager.

2. Monitors utilization of families’ authorized hours of respite weekly and addresses any urgent or unexpected needs with the Support Services Manager.

3. Plan, execute, and oversee incoming documentation of services and client satisfaction in conformance to specifications and quality deliverables.

4. Assist program operations in tracking, documenting, and reporting quality levels as well as health and safety goals/KPIs.

5. Analyze and investigate complaints or reported quality issues to ensure closure in accordance with company guidelines and external contractual requirements.

6. Develop or update company complaint and monitoring procedures to ensure capture and investigation, as well as proper documentation of complaints.

7. Carefully maintain complaint and noncompliance processing through records and tracking systems, including root cause and corrective actions recommendations.

8. Monitor risk-management procedures, and maintain and analyze problem logs to identify and report recurring issues to Support Services Manager.

9. Provide training and support to the respite team on systems, policies, procedures, and core processes with program Training staff members.

10. Coordinates and monitors documentation of respite providers in the Electronic Health Record.

11. Interpret, build upon, and comply with company quality assurance standards

12. Document quality assurance activities with internal reporting and audits

13. Identify training needs and take action to ensure company-wide compliance

14. Pursue continuing education on new solutions, technology, and skills

15. Monitors compliance of respite provider on-time services or no shows for assignments.

16. Tracks and maintains utilization reports on provider availability and accessibility.

17. Cross reference data in Myevolve with monthly and quarterly reports for quality assurance.

18. Assists in data integrity checks of all families.

19. Performs other duties as assigned***

Works within the philosophy and guidelines of the Children’s Home Network.

***THESE ESSENTIAL JOB FUNCTIONS ARE NOT TO BE CONSTRUED AS A COMPLETE STATEMENT OF ALL DUTIES PERFORMED. EMPLOYEES WILL BE REQUIRED TO PERFORM OTHER JOB RELATED MARGINAL DUTIES AS REQUIRED***

MINIMUM QUALIFICATION REQUIREMENTS:

Education & Experience:

· Bachelor’s Degree and three (3) years administrative experience in a professional office setting. Degree in Business Administration preferred.

Licenses & Certifications:

· Must possess and maintain a valid Florida driver’s license with no record of criminal driving offense of license suspension.

· Must possess means of providing job related transportation and show proof of required insurance. Must be insurable under CHI’s current auto insurance policy.

· Must be able to work flexible hours, including evenings and weekends.

· Must successfully complete and maintain FDLE clearance, Federal background and state criminal background check and sexual predator screening.

COMPETENCIES & PROFESSIONAL DEVELOPMENT:

Knowledge, Skills, Abilities & Competencies:

· Knowledge of word-processing, spreadsheet, and related basic computer software, including MS Word, MS Excel, PowerPoint, Outlook, and program specific software.

· Superb computer competence, including database management.

· Knowledge of effective office procedures and practices.

· Possess effective organizational skills.

· Knowledge of quality assurance terminology, methods, and tools.

· Analytical, problem-solving, and decision-making skills.

· Ability to communicate effectively, orally and in writing.

· Ability to establish effective working relationships with clients, co-workers, supervisors and other individuals. Possess effective interpersonal skills.

· Knowledge of agency's organizational structure, standard operating procedures, and policies.

Annual Training Requirements:

· Complete annual training requirements for Administrative personnel that include: Confidentiality and Privacy Practices, Diversity/Cultural Competency, Child Abuse and Neglect Mandated Reporter Statutes and Methods, Prevention of Violence in the Workplace, OSHA–related training, Crisis Prevention, DCF Services to Deaf and Hard of Hearing Modules 1-3, DCF Security Awareness and other Programmatic Trainings.

Essential Physical Skills:

· Visual: ability to safely operate a motor vehicle, read printed materials, and make observations of physical facilities.

· Hearing: ability to understand and comprehend spoken dialogue in individual and group settings.

· Ability to speak clearly and effectively.

· Reasonable accommodation will be made for otherwise qualified individuals with a disability.

· Ability to use a personal computer and related office equipment. Ability to use hands and fingers for typing.

· Ability to communicate verbally. Good hearing (with or without hearing device).

Environmental Conditions:

· Works within an office environment, home office or within the community.

· High level of emotional discussions, requiring self-awareness and understanding of professional boundaries.