Quality Assurance Clinical Auditor-QA535206

JOB SUMMARY:

The purpose of the Quality Assurance Clinical Auditor is to promote conformance to standards, quality improvement and corporate compliance in ICL services programs through ongoing monitoring, evaluation, consultation, education, investigation and the development of quality- and compliance-related products and processes.

ESSENTIAL JOBD FUNCTIONS:

• Reviewing Documentation: Audit clinical documentation, treatment plans, and progress notes as well as utilization reviews to ensure accuracy, completeness, and compliance with billing requirements, regulatory & quality standards, and diagnostic criteria for ICL outpatient programs and intellectual disabilities.
• Monitoring Program Effectiveness: Evaluate the effectiveness of mental health and intellectual disabilities programs in achieving desired outcomes, such as symptom reduction, functional improvement, and enhanced quality of life for individuals served. Identify opportunities for program enhancement based on audit findings and performance metrics.
• Assessing Clinical Quality: Evaluate the quality and appropriateness of clinical care provided to individuals with mental health conditions and intellectual disabilities, including assessment, diagnosis, treatment planning, and therapeutic interventions. Ensure adherence to evidence-based practices and ethical standards.
• Identifying Training Needs: Identify training needs and provide education and support to clinicians, staff, and providers on topics related to billing compliance, documentation standards, diagnostic criteria, treatment modalities, and best practices in ICL outpatient programs and intellectual disabilities care.
• Collaborating with Multidisciplinary Teams: Participation in managing clinical risks in the agency by participating Incident Review Committee Meetings, High Risk Meeting, and Sentinel Reviews. Work collaboratively with clinical teams, including psychiatrists, psychologists, social workers, therapists, and case managers, to ensure coordinated and integrated care for the clients with ICL outpatient programs and intellectual disabilities. Participation in managing clinical risks in the agency by participating.
• Facilitating Quality Improvement: Lead quality improvement initiatives aimed at enhancing the quality, efficiency, and effectiveness of the outpatient programs and intellectual disabilities services. Develop and implement strategies for addressing identified areas for improvement and promoting a culture of continuous quality improvement.
• Staying Informed: Stay updated on changes in healthcare regulations, billing requirements, reimbursement policies, and quality assurance standards relevant to mental health and intellectual disabilities services. Maintain knowledge of emerging trends, research findings, and best practices in the field.
• Data Analysis and Reporting: Analyze audit findings, performance data, and outcome measures to track program performance, identify trends, and report on key quality indicators. Prepare comprehensive reports for management, stakeholders, and regulatory agencies to demonstrate compliance and quality of care.
• Relationships with Others in the Agency: Report to the VP of Quality Assurance &Privacy Officer for supervision; consult with division administrators to develop and execute quality improvement plans, including plans of corrective action (POCAs) for certification visits and internal agency audit reports; participate in program planning projects and meetings to provide inputs on development of quality control and program evaluation elements; and conduct or participate in management meetings with service-delivery staff to establish , delineate, and review program organizational policies, to coordinate functions and operations between departments , and establish responsibilities and procedures for attaining objectives and assist with the implementation of new programs.
• Perform other related duties as assigned.

ESSENTIAL KNOWLEDGE, SKILLS AND ABILITIES:

• Evidence based practice.
• Ability to identify risks related to client safety, compliance, and quality care.
• Keeping up with evolving medical and regulatory changes. 
• Ability to educate staff on compliance issues and quality improvement continuous measures.
• Familiarity with EHRs.
• Good communication.
• Attention to details.

QUALIFICATIONS AND EXPERIENCE:

• Master’s degree and/or Bachelor’s degree in psychology, education, social work or related field with Clinical experience.
• At least two years’ experience working in a human services organization conducting assessments or evaluations, performing quality assurance work, or managing programs.