Clinical Quality Specialist

POSITION SUMMARY

Reporting to the Director of Training and Quality Assurance, the Quality Assurance Specialist is responsible for overseeing the functions of data collection and analysis, data reporting, quality assurance, and quality improvement. Responsibilities include the collection and analysis of data to ensure contract requirements are met along with minimum quality assurance and continuous quality improvement, and adherence to all DHCS, SAPC, and CARF requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES

In addition to all components of the above position summary the following “Essential Duties and Responsibilities” are essential to successful performance in this position

• Collection of data, which is evaluated, analyzed and reported to ensure contract and grant requirements are met.
• Prepare written reports and analyses setting forth progress, adverse trends, and appropriate recommendations or conclusions. Findings are reported back to Program Directors to ensure data drives program related goals.
• Drives the tools and analysis necessary to improve decision making and performance across all programs.
• Generates weekly and monthly reports utilizing Electronic Health Record to measure compliance and report program progress to county and state funders.
• Works with IT and QA team members to develop QI monitoring tools and develop reporting tools/reports.
• Working with the Director of Training and Quality Assurance and Program Director or designee develops a Quality Management Plan and system for quarterly review for the affected program; produces associated reports.
• Ensure proper CARF documentation for QR meetings are completed and uploaded
• Regularly Reviews client charts and associated records at periodic intervals to ensure compliance with County, State, and CARF requirements.
• Assesses whether clients receive the appropriate level, type and amount of services in an appropriate setting;
• Assures compliance with established record keeping standards;
• Evaluates the quality of services provided compared to clinical best practice guidelines.
• Assist and conduct utilization review for the facilities insurance clients on an as-needed basis
• Develops and monitors clinical and administrative processes to assure the quality of care and regulatory compliance.
• Enter client data and new staff data into the Electronic Health Record as needed.
• Working with the Program Director or designee develops “standards of care” for program participants; provides oversight to assure compliance with “care” standards.
• Leads or participates in workgroups to improve clinical services or processes
• Plans and provides training on relevant topics to clinicians, consumers, and Phoenix House staff, including current EBP groups required by our contracts or Phoenix House Clinical Leadership.
• Plans and provides Electronic Health Record specific training for staff
• Assesses compliance with record-keeping standards, appropriateness of services provided, and/or determines the need for additional services.
• Performs a variety of complex and independent activities involved in the collection, analysis, documentation, and interpretation of data related to quality improvement.
• Meets regularly with multi-disciplinary team members concerning client and program issues; assists in the development or modification of procedures for improvement of services.
• Develops forms and procedures to track and compile information and apply appropriate data analysis techniques to maintain tracking statistics.
• Maintains liaison with other provider agencies’ Quality Assurance, Utilization Review, and Risk Management offices as well as related administrative departments; represent Phoenix House on various quality audit and review committees.
• Stays abreast of new developments in the field of Quality Assurance/Improvement as related to mental health, recommend new policies, and revise existing policies/procedures for compliance with all applicable laws and standards.
• Assists in the process records requests.
• Leads or participates in other projects as assigned
• May assists in the preparation of grant proposals.
• Analyzes and recommends positions on policy/procedural/clinical issues, and proposals.
• Consults regarding case/issue specific clinical questions.
• Maintains provider relations.
• Represents Phoenix House at meetings, training events, and conferences.
• Provides technical assistance and consultation to clinicians and staff.
• Ensures compliance with local, state, and federal confidentiality laws and regulations.
• Attends all required staff training sessions in accordance with Phoenix House and state licensing requirements, compl