Quality Assurance Clinician (Full-time) (Venice, CA)

Reporting to the Program Director, the Quality Assurance Clinician is responsible for overseeing the functions of quality assurance, quality improvement, and utilization management. Responsibilities include the monitoring of clinical services to assure minimum quality assurance and continuous quality improvement, the supervision and tracking of the delivery of evidence-based programs at the assigned facility, and adherence to all CARF accreditation requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Conduct and oversee the implementation of all metrics for each element of the Clinical Model.
• Oversee, document, and help facilitate QR related meetings (QI, QRSUR, Health & Safety).
• Assign patient records to be audited for QRSUR
  • Responsible for auditing 30% of the QRSUR patient records.
  • Train staff on using the auditing tool for peer audits as needed.
  • Train staff on chart documentation updates and improvements.
  • Calculate the QRSUR results and review results with the QRSUR committee.
• 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 and State requirements.
  • Assesses whether clients receive the appropriate level, type and number 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.
• In collaboration with the Vice President of Quality Resources, Conducts Quarterly QR audit.
• 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.
• Working with the Regional Vice President of Quality Resources and Program Director or designee, develops a Quality Management Plan and system for quarterly review for the affected program; produces associated reports.
• 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 Welligent 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.
• Evaluate and interpret collected data and prepare written reports and analyses setting forth progress, adverse trends, and appropriate recommendations or conclusions.
• Generates the following reports:
  • Weekly Welligent Compliance Report
  • Individual Case Load Audit
  • Monthly Welligent Compliance Report
• 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.
• 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.
• 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 and completes all training on time.