QUALITY & COMPLIANCE ASSOCIATE

Description

The position will be a hybrid, with the actual number and specific days to have a physical presence at an office or other site to vary depending on workflow, work type, deadlines, etc.  Our preference is to hire people who live in the state they will be assigned to, but not imperative.  

Job Objectives:  The primary purpose of this position is to plan, organize, develop, implement, and further quality improvement and compliance functions in accordance with current applicable federal, state, and local government standards, guidelines and regulations, as well as those of agencies through which SJCS seeks accreditation. These functions should serve to promote the highest degree of quality services, outcomes, and regulatory compliance at all times.     

Essential Functions:

1. Be the primary staff person for quality, compliance and risk management efforts for the SJCS state that is assigned. Work collaboratively with other Quality and Compliance Associates and Regional Directors for Quality and Compliance on agency-wide and multi-state initiatives.
2. Conduct daily reviews of a sample of Therap input and utilization, with an emphasis on data, daily notes and other documentation to support billing. Assure that documentation meets regulatory requirements, provides quality information pertaining to services provided and how the individual responds to those services, and is presented for all shifts and services delivered. Conduct more in-depth reviews on a weekly basis and generate brief reports to summarize findings.
3. Provide feedback to staff entering Therap data and information, uploading documents, etc., and provide training, mentoring and other guidance to affect improvement with documentation.   
4. Become well-versed in the assigned state’s regulatory and funding requirements, including provider agreements and licensure standards, as well as those of oversight Federal agencies (e.g., Centers for Medicaid and Medicare Services, US Department of Housing and Urban Development). Provide training and technical assistance on the same to state staff. State agencies include but are not limited to: Virginia – Department of Medical Assistance Services, Department of Behavioral Health and Developmental Services, Department for Aging and Rehabilitative Services; District of Columbia – Department of Healthcare Finance, Department on Disability Services, Department of Health, Department of Behavioral Health, The Community Partnership for the Prevention of Homelessness; Tennessee – Department of Intellectual and Developmental Disabilities, Managed Care Organizations (BlueCare, Amerigroup, United Healthcare), TennCare; Delaware – Division of Developmental Disabilities Services, Division of Medicaid and Medical Assistance Services; New York – Tompkins County Department of Social Services, NY Office of Temporary and Disability Assistance, NY State office of Mental Health, NY Office of Addiction Services and Supports.
5. Coordinate and work with state staff to prepare for government licensure, quality and compliance reviews, and fiscal audits, and for accreditation surveys. This should include conducting preparatory internal audits (can develop teams for this process) using government and accreditation agency protocol to determine standards for which performance requires remediation before the actual government review. Coordinate state staff through the follow-up actions that are required.  
6. Serve as the focal person for state government reviews, accreditation surveys, Medicaid and other audits. Coordinate team members through these audits to assure required documentation, access to services, staff and individuals, and other information needs of auditors are met.
7. In conjunction with state staff, develop Corrective Action and Quality Improvement Plans in response to audit, survey and review findings. Monitor the implementation and effectiveness of these plans, and facilitate refinements as needed.
8. Build the capacity of state staff to carryout quality and compliance functions. Work with state staff to develop, implement and refine processes and activities for quality and compliance including incident management, risk management, quality improvement plan development and implementation, and licensure among other areas.
9. Manage the state’s incident management system. This includes coordination with any staff that serve as incident management coordinators, and fulfilling that role in the absence of such staff. Enter data into state systems, and generate incident tracking and trending reports from those state systems and internally. Conduct root cause analyses of serious incidents and on a quarterly basis assess all incidents to identify any systemic issues. In conjunction with state staff, develop and oversee plans of action to address systemic issues.
10. Become a certified investigator for the assigned state. Conduct investigations as requested by state leadership and/or required by state agency regulations and guidelines. Develop, sound detailed reports of each investigation. On a quarterly basis assess all investigations to determine if any systemic issues exist. In conjunction with state staff, develop and oversee plans of action to address systemic issues.
11. Collaborate with HR staff in conducting compliance monitoring reviews of personnel records.
12. Utilize data and information generated from all activities to develop and guide the implementation of quality improvement plans and actions.
13. Stay current of quality improvement and compliance monitoring methods, regulations, functions, issues, best practices and the like. Use this learning to better inform and guide SJCS QI and compliance efforts, including serving as a resource for staff on these matters.
14. Perform other job-related duties as assigned.

Qualifications

Required Knowledge, Skills, and Abilities 

1. Ability to gain working knowledge of St. John’s Community Services policies and procedures.
2. Ability to act as a representative of St. John’s Community Services to the public.
3. Ability to effectively communicate with individuals from diverse backgrounds.
4. Ability to research, prepare, maintain and review reports and documents timely and accurately.
5. Ability to learn, understand, and interpret regulations from varied sources.
6. Ability to multitask and meet deadlines.
7. Ability to be flexible and meet outcomes as assigned.
8. Ability to maintain confidentiality.
9. Skilled in the operation of relevant computer systems, including hardware and software, and simple office machines.
10. Ability to provide training to SJCS personnel, including new hires
11. Must be well organized and detail oriented.

Education and Experience

1. Requires Bachelor’s degree in human services, social sciences, health administration, data management, or related field.  
2. Two or more years of experience managing quality and compliance activities.
3. Experience with electronic records systems, databases, reviewing data to determine program outcomes, conducting field interviews and reviews, and investigatory tasks.
4. Must meet SJCS and funding jurisdiction requirements for criminal background/records check.
5. Valid health certificate to meet funding jurisdiction requirements required
6. Experience with government, human services, auditing preferred

Physical and Environmental Conditions

Work environment involves everyday risks or discomforts that require normal safety precautions typical of such places as offices, e.g., use of safe workplace practices with office equipment, and/or avoidance of trips and falls.

The position can be fulfilled remotely, with some travel required for meetings, QI and Compliance Activities, and other work that would need to be conducted in person.