The QA Specialist promotes and ensures protections of client rights; Conducts investigations into allegations of abuse or neglect; Conducts and supports activities to ensure compliance with regulatory and accrediting agencies, payers, and placing agency contracts; Engages in activities to support continuous quality improvement initiatives; May be contacted during non-scheduled times for consultation or action, as needed. Promotes Grafton’s mission and performs job functions in a manner consistent with Grafton’s values and beliefs; Has matrix reporting to the Director of Quality Assurance and Compliance.

Essential Job Functions

Implements qualitative and quantitative audits and related activities to assure compliance with applicable state and federal regulations and standards, as well as contract requirements and payer stipulations including Medicaid requirements. Prepares and disseminates specialized data reports for management use. Stays current with relevant regulatory/Medicaid changes and serves as resource for answering related questions; Supports preparation activities for licensing surveys and other external reviews and supports activities during related review activities; Maintains licensure through the completion and submission of initial/renewal/modification of licensure applications.

Conducts audits, trainings, and other activities to assure regional compliance with applicable accreditation standards, such as CARF; Serves as on-site resource for questions pertaining to accreditation compliance; Supports preparation activities for accreditation surveys and facilitates on-site visits by accrediting body.

Conducts audits to support regional and organization continuous quality improvement processes; Audits may involve areas such as client documentation, physical environments, and employee training; Provides audit findings to Executive Director and Quality Assurance and Compliance Director and monitors for completion of follow up actions identified; Produces data reports as requested by the Quality Assurance and Compliance Director or Executive Director.

Reviews, edits, and closes Serious Incident reports within the organization’s electronic client record (ECR); Ensures processing occurs of serious incidents with corrective action plans, as needed; Collaborates with other department staff on the production of specialized reports for purposes such as tracking of processing, identification of trends, and in support of program development of action plans; Provides related information to members of the regional operating team including the Executive Director; Provides training and feedback to managers designated to write incident reports; Operates efficiently within the ECR to review client documentation and utilizes the Data Warehouse to generate/analyze reports to assure ongoing compliance.

Receives reports of alleged abuse or neglect; Notifies applicable external agencies of allegations; Coordinates investigations with external agencies; Conducts internal investigations; Assures protection of clients’ rights including protection from harm and confidentiality; Prepares report of investigation findings and makes recommendations for corrective action; Engages in extensive professional communications and collaboration with all involved external investigative/ oversight agencies; Takes similar actions and holds equivalent responsibilities for any other serious incident involving a client that also includes investigation/oversight by an external entity.

Makes external notifications of certain serious incidents as needed for compliance with regulatory standards and Medicaid and other payer requirements; This involves use of identified state electronic systems, such as the reporting system for BIRFs; Stays current on changes to external reporting requirements and assures all required information and documentation are submitted within identified timeframes.

Facilitates development of internal and external corrective action plans and monitors implementation of corrective action plans; provides status reports, as requested, to the Quality Assurance and Compliance Director and Executive Director; Analyzes trends related to citations and corrective actions and acts in accordance with findings.

Acts as an objective party to hear concerns or complaints about alleged human rights violations; Investigates and facilitates resolution; Reports complaints as necessary to required external agencies; Facilitates external review of such matters; Assures information is entered into corporate tracking system, including resolution of complaints and monitors related data for trends and consistency in processes organization-wide; Assures protection of clients’ rights through activities such as review of proposed restrictions, consideration of program guidelines and activities, monitoring use of pat downs and property searches, and ongoing monitoring of implemented environmental/individual restrictions.

Utilizes the organization’s video camera system in accordance with Grafton’s policies and procedures; Assures the identified program’s system is operating properly; Assures necessary recordings are saved in a confidential secure manner and are only released in accordance with policy and procedure and legally authorized processes.

MINIMUM QUALIFICATIONS

• Requires a Bachelor’s degree in a related field and a minimum of two years related experience providing and reviewing services, investigating allegations of client abuse and neglect, leading quality improvement initiatives, or interpreting and applying licensure standards to human services programs OR
• HS/equiv. and a minimum of five years experience in the human services field with at least two years providing and reviewing services, investigating allegations of client abuse and neglect, leading quality improvement initiatives, or interpreting and applying licensure standards to human services programs.
• Requires a valid driver’s license.
• Requires a working knowledge of applicable regulations.
• Completion of all required trainings. Maintains all required annual certifications.

EMPLOYEE BENEFITS

• Medical, dental and vision
• Flexible Spending & Health Savings Accounts
• 401(k), including an employer match
• Generous Paid Time Off plan
• Education Assistance
• Life Insurance
• Employee Assistance Program (EAP)
• Short-term disability (STD)
• Long-term disability (LTD)
• As Grafton is a 501(c)(3) non-profit, you may be eligible for federal student loan forgiveness

Grafton is an equal employment opportunity employer and tobacco-free workplace.

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