Quality Assurance/Risk Management Coordinator

Commonwealth of PA | Dauphin County, PA

Posted Date 11/07/2019
Description Are you passionate about providing quality services to our most vulnerable citizens? Are you detail-oriented? Do you possess excellent communication and critical thinking skills? If so, consider joining the Office of Mental Health and Substance Abuse Quality Management Division, Division of Quality Management.  

IMPORTANT:  YOU MUST APPLY TO THIS VACANCY POSTING, MEET ELIGIBILITY REQUIREMENTS, COMPLETE THE SUPPLEMENTAL QUESTIONS, AND RECEIVE A SCORE.  YOUR SCORE IS ONLY VALID FOR THIS SPECIFIC VACANCY.  ONCE THIS POSITION IS FILLED, YOUR SCORE IS NO LONGER VALID.
 
  • Full-time employment
  • Work hours 8:00 am - 4:30 pm, Monday - Friday; 1 hour lunch
  1. Conducts quality assurance and risk management reviews of BH HC Primary Contractors and BH-MCOs for regulatory compliance to state and federal regulations, standards and performance of operations relative to the HealthChoices Program.
  • Completes Annual & Triennial Program Evaluation and Performance Summary (PEPS) Reviews for assigned Counties, BH HC Contractors and BH-MCOs.
  • Monitors and evaluates BH-MCO Service Denial Letters for clarity and adherence to medical necessity language.
  • Participates in BH-MCO Onsite Reviews which includes conducting interviews and reviewing documentation that targets identified service areas for medical necessity, appropriateness, access, quality, risk and efficient and effective delivery of care.
  • Serves as an OMHSAS staff resource for analyzing and interpreting new and existing regulations, policies, procedures, standards, and clinical guidelines relative to quality in behavioral health services.
  • Reviews, interprets and analyzes proposed legislation that has reference or impact on Behavioral Health services and provides written input to the OMHSAS response generated by the Bureau of Policy and Program Development.
  • Participates in the development and implementation of systems for reviewing and monitoring data and quality benchmarks, plans, policies, procedures and timetables for quality assurance/risk management activities to be implemented by counties and Behavioral Health Managed Care Organizations.
  • Effectively identifies and addresses deficiencies in compliance and assigns Corrective Action Plans (CAPs), as necessary, that drive increased access, quality improvement, efficiency of service provision and the implementation of clinically sound and evidence-base practices.
  • Reviews BH HC data submissions for data submissions and develops and provides regular and special request reports both orally and in writing that include data displays and use of Microsoft Excel, PowerPoint, Word and Outlook.
  • Prepares written and statistical reports, and compiles data analyzing the trends and outcomes regarding OMHSAS program and service initiatives that are reported to the Executive level of OMHSAS, other OMHSAS and Department personnel, consumers, counties, primary contractors and BH-MCOs.
  • Participates in external quality review meetings and activities in order to ensure compliance with Federal and State regulations related to the HealthChoices program.
Qualifications:
  • Must meet PA residency requirement – For more information on ways to meet PA residency requirements, follow the link and click on Residency
  • Minimum Experience and Training Requirements  - One year as a Quality Assurance/Risk Management Specialist; OR three years of professional experience as a member of a multiple disciplinary treatment team in a public or
    private health care facility and a bachelor's degree; OR three years of clinical experience in a human services agency, including two years of administrative, evaluative, consultative or supervisory work in a health care program; and a bachelor's degree with major course work in social work, nursing, health care administration, behavioral sciences or a related field; OR any equivalent combination of experience and training.
  • Must be able to perform essential job functions


Veterans: Pennsylvania law (51 Pa. C.S. §7103) provides employment preference for qualified veterans for appointment to many state and local government jobs.  To learn more about employment preferences for veterans, go to www.employment.pa.gov/Additional%20Info/Pages/default.aspx and click the Veterans' Preference tab or contact us at ra-cs-vetpreference@pa.gov.

Telecommunications Relay Service (TRS):  711 (hearing and speech disabilities or other individuals)
 
The Commonwealth of Pennsylvania is proud to be an equal opportunity employer supporting workplace diversity.

  • Score valid for this specific posting only
  • Score based on information reported on application and supplemental questions
  • Provide complete and accurate information or:
    • score may be lower than deserved
    • application processing may be delayed
    • disqualification may result
  • May only test once under this announcement
  • Email notice of test results provided

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