Consumer Rights Officer (Hybrid/Remote Options)

Competitive Compensation & Benefits Package!

• Annual incentive bonus plan
• Medical, dental, and vision insurance with low deductible/low cost health plan
• Generous vacation and sick time accrual
• 12 paid holidays
• State Retirement (pension plan)
• 401(k) Plan with employer match
• Company paid life and disability insurance
• Wellness Programs
• Public Service Loan Forgiveness Qualifying Employer

Primary Purpose of Position: This position will serve as Consumer Rights Officer for Partners by managing incident reports through the investigation and analysis phase and following local and state policies collaboratively with internal staff and external agencies as well as consumer and their families.

Role and Responsibilities:

75% INVESTIGATION PROCESS: Serve as the lead coordinator for referrals for cross-functional team investigations concerning consumer rights violations and issues about provider’s practices which will require a multi-disciplinary team investigative approach. This involves, but is not limited to:

• Develop, plan, and implement investigative strategies and processes
• Coordination and facilitation of an investigative team to address multifaceted concerns and complaints
• Data mining, data analysis to identify trends and patterns of aberrant practices
• Conduct clinical and non-clinical investigative interviews, as necessary, to facilitate the investigative process
• Complete all appropriate investigative documentation, report findings, make recommendations
• Serve on various agency committees as deemed appropriate by Supervisor
• Coordinate training and education initiatives with appropriate agency personnel to address patterns and trends of aberrant practices

25% CONSUMER RIGHTS OFFICER: Serve as liaison for consumers, family members, legal representatives, guardians, providers, and community stakeholders regarding all adverse events. Handles database reporting for all reports including the Incident Response Improvement System. Maintains records of information received and responses tracking resolution timelines Responds to questions in a timely manner using tact and diplomacy.

• Provides internal and external training on consumer rights laws as needed.
• Performs other applicable duties as assigned.

Knowledge, Skills and Abilities:

• Comprehensive knowledge of consumer rights in Mental Health, Intellectual & Developmental Disabilities, and Substance Use (MH/I-DD/SU) field
• Comprehensive knowledge of investigative methods and processes
• Considerable knowledge of applicable State, Federal laws and guidelines related to consumer rights, confidentiality, MH /I-DD/SU billing and documentation requirements, in addition to healthcare fraud, waste, and financial abuse
• Knowledge of cultural diversity and the ability to create and maintain strong relationships with a variety of consumers, families, staff and stakeholders
• Working knowledge of statistical methodologies and analysis
• Knowledge of administrative codes, laws, statutes and LME/MCO administrative regulations to assist in facilitating resolution and to prepare written investigative reports
• Exceptional interpersonal and communication skills
• Strong problem solving, negotiation, arbitration, and conflict resolution skills
• Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint
• Effective time management and organizational skills
• Excellent analytical skills
• Demonstrated ability to effectively communicate in writing and orally with staff, consumers, providers and other entities with tact and diplomacy
• Demonstrated ability to work across departments with effective team building skills
• Ability to learn and effectively manage various information systems
• Ability to interpret contractual agreements, business-oriented statistics, clinical/administrative service records
• Ability to maintain strict confidentiality in all areas of work
• A high level of integrity and discretion is required to effectively carry out the responsibilities related to this position

Education and Experience Required: Master's Degree in a Human Services field with NC Clinical Licensure or Nursing degree with license to practice as a Registered Nurse in NC. Minimum of four (4) recent continuous years of experience in MH/SU/IDD including consumer rights advocacy and compliance monitoring, auditing, and/or investigative experience.

Education and Experience Preferred: Education above plus five years recent continuous experience in MH/SU/IDD with two (2) of the five (5) years including experience analyzing complex data, claims management, utilization reviews, managed care, and/or healthcare fraud or financial abuse detection. Minimum of two (2) years continuous supervisory, lead, or team management experience within the last five (5) years. RN licensure is preferred.

Licensure/Certification Requirements: Current unrestricted LCSW, LCMHC, LPA, LMFT, LCAS, or RN licensure with the appropriate professional board of licensure in North Carolina. Must have BASIC National Certification as an Investigator/Inspector through the Council on Licensure, Enforcement & Regulation (CLEAR). Employee is responsible for complying with respective licensure board’s continuing education/ training requirements in order to maintain an active license.