Quality Assurance Specialist - Per Diem

Quality Assurance Specialist - Per Diem (Sepulveda) 

This is a hybrid position based in Culver City, CA. Candidates must be local to Southern California.

This is a flexible and per diem schedule with infrequent weekdays onsite required.

The pay range for this role is between $26.37 - $30.33 per hour.

About Didi Hirsch   

Didi Hirsch Mental Health Services has been a national leader in whole-person mental health, crisis care, and substance use services since 1942 and is home to the nation’s first Suicide Prevention Center. We are a nonprofit organization providing care to nearly 200,000 people annually across our programs. Didi Hirsch has deep roots in community-based mental health and a commitment to providing culturally responsive services that are just and equitable.    

As an organization, we value equity, diversity, and inclusion. More than 1,000 dedicated employees and volunteers make Didi Hirsch’s work possible. We intentionally recruit and retain a workforce that is reflective of the communities we serve and strive to cultivate a sense of belonging for them. We embrace employees and candidates from all backgrounds who want to help make this vision a reality.    

Summary

As a Quality Assurance Specialist (Per Diem), you will perform general quality assurance duties, with primary focus on credentialing and re-credentialing activities according to Didi Hirsch and contracted health plan policies, DMH, DHCS, CMS, and NCQA accreditation guidelines. You will also ensure provider compliance with appropriate enforcement bodies, as well as assist with necessary agency certifications, licensing, credentialing and accreditations.

Primary Duties

• Organizes, maintains and verifies that the professional training, certifications and licensing of healthcare providers are up to date and in compliance with state, federal, and agency regulations.
• Ensures compliance of all providers with the credentialing and re-credentialing process with various public (Medicare/Medi-cal) and private managed health care agencies.
• Participates in the development and implementation of credentialing processes and procedures.
• Maintains accuracy and integrity of various practitioner databases detailing the providers’ discipline type, such as: NPI, DEA and license numbers, language capacity, licensure and credentialing renewal dates, etc.
  • Maintains and submits the Network Adequacy Certification Tool data, including service location and practitioner level information, to comply with state network adequacy requirements.
  • Maintains the Provider Application and Validation for Enrollment (PAVE) portal for DHCS to enroll and update providers in Medi-cal Fee for Service.
  • Submits practitioner updates to DMH using the online Practitioner Registration & Maintenance (PRM).
  • Maintains up-to-date user profiles in the agency’s Electronic Health Record systems.
• Acts as a liaison between our agency and contracted health plans to ensure proper credentialing and re-credentialing with various managed healthcare organizations (Beacon, Aetna, Healthnet).
• Assists in all necessary agency certifications, licensing, credentialing and accreditations.
• Remains abreast of contractual requirements and fulfillment set forth by managed care companies.
• Assists with development of metrics necessary for reporting requirements.
• Assists with the Medi-cal and DHCS certification and re-certification process.
• Provides assistance in agency seeking accreditation with National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC). 

Position Requirements

• Minimum requirement is an Associate’s Degree; Bachelor’s Degree preferred.
• Minimum of 2 years of Quality Assurance experience required. 
• Meticulous attention to details to ensure accuracy and completeness of agency records.
• Strong organizational skills and ability to juggle multiple deadlines.
• Very clear oral and written communication skills.
• Strong working knowledge of managed health care plans preferred.
• Demonstrates strong customer-service oriented interpersonal skills.
• Flexibility and ability to adapt to changing priorities and needs.
• A commitment to team objectives and Didi Hirsch philosophies.

Our Vision

A future where everyone has equitable access to care and is empowered to achieve optimal mental health and well-being.

Our Mission

Didi Hirsch provides compassionate mental health, substance use, and suicide prevention services to individuals and families, especially in communities where discrimination and injustice limit access.

CORE VALUES

Excellence: We are constantly innovating, learning from the communities we serve, and applying the latest research to advance best practices. We uphold the highest ethical standards to ensure we are providing compassionate and excellent care.
Diversity & Inclusion: We value diversity of background, experience, and ideas, committing to a workforce representative of the communities we serve. We celebrate differences and prioritize creating a sense of belonging.
Equity: We are dedicated to maintaining equitable practices in our healthcare delivery and workplace culture, and we work to dismantle disparities and discrimination within both systems of care and society.
Well Being: We are devoted to the well-being of our staff, volunteers, and communities, and believe healthy teams lead to healthy clients.
Advocacy: We advocate across all levels of government and use our voice to reduce barriers to care, including stigma, systemic racism, and parity across payers, with the goal of access to high quality, integrated healthcare for all.
Community Engagement: We build partnerships in the community and across sectors to create a more inclusive and responsive mental health ecosystem and enhance greater accessibility to care and support.

#LI-KJ1 #LI-Hybrid 

Salary : $26 - $30