Quality Management Specialist-BHS-HHK-Sacaton

Position Summary: At the direction of the Quality Management Specialist Lead, ensures that all Behavioral Health departments and staff members continually improve service and patient outcome quality as determined statistically based upon Behavioral Health patient outcomes by performing the following duties personally. As directed, assists in the management and daily operations of the RBHA provider network activities to ensure ongoing compliance with established state, federal and licensing regulations and standards. Responsible for ensuring that all critical tasks are fulfilled on a timely basis.

Critical Tasks:

• Maintains exclusive focus upon patients/residents served, the quality of their care, their individual needs and their medical outcomes without significant distraction by administrative and non-patient subject activities.
• Assists with daily operations of the RBHA provider network process to ensure compliance with established professional, regulatory and governmental standards.
• Complies fully with all patient/resident medical records and information privacy regulations, state and federal.
• Takes all steps necessary to fully ensure employee patient/resident and medical data confidentiality and security by all department staff.
• Ensures that all behavioral health services provided result in improved medical outcomes for all patients served while ensuring patient and resident needs are met in accordance with all contemporary behavioral health standards and regulations, particularly regarding the Centers for Medicare and Medicaid Services (CMS).
• Engages in studies and investigations related to improving behavioral health care and outcomes.
• Develops educational plans for in-service education and orientation of behavioral health staff. Ensures that all staff actions are highly contributive to patient and resident well-being.
• Ensures accurate completion and secure retention of Accident, Death, Incident, Restraint and Seclusion reports.
• Oversees complaint filings including complaints of network providers; and takes all steps necessary to resolve such filings based upon only facts and evidence without regard to false information and unfounded allegations. Facilitates and oversees corrective action as appropriate based on findings.
• Performs site visits of provider agencies; performs record reviews, tours facilities, interviews and discusses concerns/issues with staff.
• Monitors status of Provider Agencies for compliance with policies and contractual requirements.
• Ensures that no violations of federal health care regulations occur as the result of conflicting facility policies, practices and procedures.
• Participates with supervisor on proper response and remediation of quality of care investigations without regard to all non-evidenced allegations and inferences.
• Maintains and updates electronic provider information database to ensure accuracy and timeliness of information.
• As directed by supervisor, confers with supervisors and staff to ensure efficiency and high-quality outcomes of all behavioral health services and programs.
• Actively participates on a patient centered basis within the Quality Improvement Committee and Provider Network meetings while ensuring that all Committee activities occur with high efficiency and little time consumed.
• Complies with all internal and external documentation and reporting deadlines, including files required of Provider Network activities
• Assists in the preparation for all regulatory or contract reviews and surveys.
• Updates department policies and procedures as necessary according to best external behavioral health practices and contemporary standards of operation.
• Reviews, evaluates, and interprets behavioral health records, vital statistics, and other data affecting behavioral health service to assess patient and community needs and to plan and implement patient/resident programs to meet those needs.
• Participates in a variety of department and hospital educational programs to maintain current skill and competency levels; identifies and discusses performance or training needs with Supervisor.
• Demonstrates ability to regularly change priorities to accomplish all tasks despite frequent interruptions.
• Demonstrates ability to clearly communicate, both orally and in writing, while performing all essential functions.
• Performs other special projects and duties as assigned.

Required Qualifications:

• Bachelor’s Degree in Social Work, Counseling, or closely related field of study from an accredited university or college; Master’s degree preferred.
• 3 years of experience in a Behavioral Health Services capacity required.
• Current Arizona license LCSW, LPC, LMFT, LISAC, LMSW, LAC, LAMFT, LBSW, or LASAC in good standing with AZBBHE required.
• State of Arizona driver’s license with no significant violations during the last 5 years.
• Current State of Arizona Department of Public Safety Fingerprint Clearance Card required.
• Current and continuing CPR and AED training and certifications required.
• Demonstrated ability to relate to diverse cultures and specifically the Gila River Community and/or other Native American cultures and community health services