Quality Management Specialist I/II

Are you passionate about enhancing the quality of care in Health and Human Services, with a focus on Behavioral Health Services? We are seeking a dedicated Quality Management Specialist to join the Quality Management Team in the ongoing development, evaluation, and monitoring of our quality assurance and utilization review programs. In this vital role, you will collaborate with diverse teams, utilizing your curiosity and attention to detail to drive meaningful improvements.

Your independent judgment will be key in prioritizing and coordinating departmental activities, ensuring compliance with quality assurance standards. Additionally, you’ll have the opportunity to bring data alive, transforming insights into actionable strategies that elevate the quality of our services. If you’re ready to make a significant impact in the field of behavioral health, we’d love to hear from you!

Under general direction of the HHSA Director or designee, this position will be responsible for the development, evaluation and monitoring of quality assurance and utilization review programs for Behavioral Health Services. Incumbents use considerable independent judgment in prioritization and coordination of department activities for Quality Assurance compliance.The following duties are typical for this classification. Incumbents may not perform all of the listed duties and/or may be required to perform additional or different duties from those set forth below to address business needs and changing business practices.

• Audits medical records for compliance with Federal, State and Program standards.
• Implements and monitors service quality in accordance with state or federal standards, laws, regulations, and policies.
• Provides training for staff and contract providers on updated quality assurance requirements.
• Gathers  data,  prepares  reports,  conducts  studies  and  research  on  utilization   review  and quality assurance.
• Maintains documentation of complaints and grievances.
• Reports outcomes and other data to State as required by contract, law or regulations.
• Monitors compliance with response timelines for access, treatment authorization requests and payment.
• Develops, updates and monitors the cultural competency plan.
• Monitors progress and develops reports required by the annual Quality Management Work plan.
• Implements utilization review and quality assurance reviews; coordinates Quality Improvement Committee.
• Serves on local and state committees or task forces.
• Monitor agreements and contracts with providers as assigned.
• Initiate, develop and revise written policies and procedures for quality management and compliance programs.
• Plan and oversee regular and periodic audits and internal reviews of operations.
• Work closely with managers in developing program policies which meet federal, state, and local government requirements.
• Attend relevant state and regional meetings.

Knowledge of:

Mental health and Substance Use methods for intervention and treatment; Legislation and laws which regulate the operations of public behavioral health programs at the local level; operations of mental health services at the state and local level; principles and practices of program  planning  and  evaluation,  needs  assessment,  and  research  methodology;  community resources  and  service  agencies, social  and economic problems which call for the use of public and private services; principles and practices of casework methodologies; quality review/quality assessment principles, practices, methods and techniques; Federal, state and County regulations and policies pertaining to utilization review; cultural, socio-economic and language factors that affect service delivery to ethnic populations.

Ability to:

Plan, organize and coordinate program development and planning function; Develop and monitor performance standards; Develop and evaluate operational policies and procedures; Analyze problems and complaints  and identify solutions; Prepare and interpret a variety of narrative and  statistical  data  and reports; Communicate orally and in writing on a variety of issues; Understand, interpret and apply procedures, laws, rules and regulations as they apply to assigned area; Ensure compliance with federal, state and local guidelines, policies, rules and regulations; Develop and maintain harmonious relationships with  employees,  public  officials,  community  groups, other  agencies  and the general public; review and interpret healthcare documentation; ascertain facts through examination of records; collect, interpret and evaluate data; interpret complex regulations, laws and guidelines, formulate policies and procedures; prepare concise, logical oral and written reports and explain policies, procedures and recommendations; communicate effectively both orally and in writing; prepare and maintain accurate records.

EDUCATION AND EXPERIENCE:

Quality Management Specialist I
A Baccalaureate degree from an accredited college and a minimum of four years’ experience in an outpatient behavioral health setting, preferably with two years in a planning or administrative capacity.

Quality Management Specialist II
Licensure in California as a Licensed Clinical Social Worker (LCSW), Marriage and Family therapist (MFT), or related California license is required.Possession of a valid California driver's license.

Salary : $76,960 - $104,291