What are the responsibilities and job description for the Quality Assurance Risk Management Coordinator position at Commonwealth of PA?
THE POSITION
Are you a passionate and committed professional with a strong desire to ensure high-quality behavioral health services are delivered to Pennsylvania residents? The Department of Human Services is seeking an exceptional Quality Assurance Risk Management Coordinator to join our Division of Quality Management team. In this pivotal role, you will play a key part in advancing the Commonwealth's efforts to continuously monitor, assess, and enhance the accessibility and quality of health services offered. If you are ready to elevate your career and take on a fulfilling new challenge, this is the perfect opportunity for you!
DESCRIPTION OF WORK
This management-level position involves synthesizing data from various sources to assess compliance and identify risks related to Medicaid Behavioral HealthChoices standards for Managed Care Organizations (MCOs) and individual primary contractors. In this role, you will oversee and monitor Pennsylvania's Behavioral Health Choices program, conducting annual compliance reviews and on-site evaluations every three years for behavioral health managed care organizations in the state to ensure compliance with state and federal regulations. The position also includes reviewing MCO quality management program descriptions, work plans, annual evaluations, provider profiles, and policies and procedures. Additionally, you will assess service denial letters, member complaints, and performance measure outcomes to ensure they meet department contract requirements. As a key team member, you will provide expert guidance in analyzing and interpreting new and existing regulations, policies, procedures, standards, and clinical guidelines, ensuring the high-quality delivery of behavioral health services while offering targeted technical assistance to various business partners.
Interested in learning more? Additional details regarding this position can be found in the position description.
Work Schedule and Additional Information:
- Full-time employment, 37.5 hours per week
- Work hours are 8:00 AM to 4:30 PM, Monday - Friday, with a 60-minute lunch.
- Telework: You may have the opportunity to work from home (telework) part-time with a minimum of one day per month in the office or as required. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg.
- Salary: In some cases, the starting salary may be non-negotiable.
- You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.
REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY
- One year as a Quality Assurance/Risk Management Specialist (Commonwealth job title or equivalent Federal Government job title, as determined by the Office of Administration); or
- Three years of professional experience as a member of a multiple disciplinary treatment team in a public or private health care facility and a bachelor's degree; or
- Three years of clinical experience in a human services agency, including two years of administrative, evaluative, consultative or supervisory work in a health care program; and a bachelor's degree with major course work in social work, nursing, health care administration, behavioral sciences or a related field; or
- Any equivalent combination of experience and training.
Other Requirements:
- You must meet the PA residency requirement. For more information on ways to meet PA residency requirements, follow the link and click on Residency.
- You must be able to perform essential job functions.
How to Apply:
- Resumes, cover letters, and similar documents will not be reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
- If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.
- Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.
- Failure to comply with the above application requirements may eliminate you from consideration for this position.
Veterans:
- Pennsylvania law (51 Pa. C.S. §7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.employment.pa.gov/Additional Info/Pages/default.aspx and click the Veterans’ Preference tab or contact us at ra-cs-vetpreference@pa.gov.
Telecommunications Relay Service (TRS):
- 711 (hearing and speech disabilities or other individuals).
If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.
The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.
EXAMINATION INFORMATION
- Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).
- Your score is based on the detailed information you provide on your application and in response to the supplemental questions.
- Your score is valid for this specific posting only.
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You must provide complete and accurate information or:
- your score may be lower than deserved.
- you may be disqualified.
- You may only apply/test once for this posting.
- Your results will be provided via email.
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Health & Wellness
We offer multiple health plans so our employees can choose what works best for themselves and their families. Our comprehensive benefits package includes health coverage, vision, dental, and wellness programs.*
Compensation & Financial Planning
We invest in our employees by providing competitive wages and encouraging financial wellness by offering multiple ways to save money and ensure peace of mind including multiple retirement and investment plan options.
Work/Life Balance
We know there’s more to life than just work! Our generous paid leave benefits include paid vacation, paid sick leave, eight weeks of paid parental leave, military leave, and paid time off for most major U.S. holidays, as well as flexible work schedules and work-from-home opportunities.*
Values and Culture
We believe in the work we do and provide continual opportunities for our employees to grow and contribute to the greater good. As one of the largest employers in the state, we provide opportunities for internal mobility, professional development, and the opportunity to give back by participating in workplace charitable giving.
Employee Perks
Sometimes, it is the little “extras” that make a big difference. Our employees receive special employee-only discounts and rates on a variety of services and memberships.
For more information on all of these Total Rewards benefits, please visit www.employment.pa.gov and click on the benefits box.
- Eligibility rules apply.
