The Assistant Director of Clinical Quality Management (ADCQM) is responsible for identifying, addressing, and implementing quality assurance and improvement activities focused on service management and delivery in strict accordance with federal and state regulations, as well as contractual obligations. Collaborating closely with the Director of Nursing and the Case Management team, you will enhance the quality of care delivery for all patients. Your role involves planning and managing the clinical quality assurance and improvement program, fostering a culture of continuous improvement and quality excellence throughout the organization. You will actively contribute to aligning policies with current best practices and lead or participate in initiatives to develop new programs. This role is inherently metric-centered, requiring you to manage internal and external audits, complete evaluations and interventions, and make recommendations based on trends in client and home care worker data, as well as requests and requirements from contractors and regulators.

RESPONSIBILITIES:

General functions

• Provide the Chief Executive Officer with data and feedback on trends in the clinical, case management, intake, and HR departments, including service delivery, client documentation, issues management, audit and compliance activities, and client and HCW satisfaction.
• Collaborate with senior leadership and quality management teams to develop and maintain quality improvement metrics. Guide the establishment of quality standards, benchmarks, and performance measures. Lead the organization's quality improvement programs in coordination with contractors and regulators.
• Remain informed about all regulations and collaborate with the agency to promptly update policies as needed. Adapt regulations from OMIG, DOH, HRA/MCO plans, and any state and federal regulatory mandates.
• Work with the Associate Director of Quality and Compliance to manage all third-party vendor and/or state audits, as required.
• Prepare regular reports on clinical quality metrics and performance indicators for leadership presentations. Cover areas such as compliance, client experience and satisfaction management, incident and complaint management, and audit findings.
• Assist with other programmatic and strategic planning tasks as assigned by management.

Audit & Compliance Management & Review

• Lead the Agency’s Audit Team and collaborate closely with all departments.
• Monitor trends and devise solutions for addressing gaps identified in the results from the Internal Claims Audit.
• Regularly review compliance reports to pinpoint opportunities for implementing quality programs aimed at addressing any identified gaps.
• Provide monthly compliance reports and audit results to the CEO & DBO, and quarterly reports to the Continuous Quality Improvement (CQI) Committee and Corporate Compliance Committee. Serve as an alternate leader for the CQI and NQoC programs.
• Spearhead the program for improvement by developing written action plans that outline specific, measurable, attainable activities aimed at enhancing any deficiencies observed in documentation/records. Offer guidance to leaders on suitable QI activities (e.g., staff training, coaching) to bolster overall leadership proficiency in quality oversight—ensuring goals are SMART (Specific, Measurable, Achievable, Relevant, Time-bound).
• Lead root cause analyses and ensure timely completion of corrective action plans, escalating issues as necessary.
• Maintain a log of all reports to be submitted to the Department of Health (DOH) and ensure timely submission of all regular or ad hoc clinical compliance reports to regulators and contractors.

Continuous Quality Improvement

• Support ongoing education of the Agency’s staff regarding the Quality Improvement Program for compliance and audit functions. Provide guidance and coaching to department heads on best practices and gap resolution.
• Collaborate with the Director of Nursing and Case Management supervisors to manage Continuous Quality Improvement trends. Ensure timely identification of gaps and implementation of recommendations from internal reviews or audits.
• Offer feedback to the Director of Nursing on trends in clinical documentation, including challenges with completion, timeliness of documentation and nursing visits, and compliance issues related to nursing documentation and service delivery.
• Lead the Associate Director of Quality & Compliance and work with the management team to maintain standardized quality, audit, and compliance management programs across the agency. Ensure compliance with regulatory and contractual requirements for all agency programs.
• Identify, develop, and manage the execution of training initiatives to enhance clinical knowledge across all staff levels.
• Oversee the investigation and resolution of all clinical and case management corrective action plans for individual clients. Monitor the effectiveness of remediation strategies and adjust as necessary.
• Conduct internal audits on client charts, incident, and complaint management, and service outcomes to proactively identify gaps in processes and practices of the clinical and case teams.
• Monitor trends for incidents, complaints, and gaps in care provided by home care workers. Facilitate appropriate interventions to address underlying issues.

QUALIFICATIONS:

• Minimum of a bachelor’s degree in human services, nursing, social work, management, or related fields; master’s degree preferred.
• Required to be a licensed registered nurse.
• A minimum of eight (8) years of work experience.
• 3 years of experience working in community and home health care.
• 3 years of supervisory experience.
• Good analytical, problem-solving, and decision-making skills.
• Detail-oriented and precise with excellent organization skills.

Job Type: Full-time

Pay: $95,000.00 - $110,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Parental leave
• Retirement plan

Schedule:

• 8 hour shift
• Monday to Friday

Work setting:

• In-person
• Office

Ability to Relocate:

• Brooklyn, NY 11206: Relocate before starting work (Required)

Work Location: In person