Quality Management Assistant

Quality Management Whiteriver, Arizona


Description

 

WHITE MOUNTAIN APACHE BEHAVIORAL HEALTH SERVICES, INC.

JOB DESCRIPTION

 

POSITION: QUALITY MANAGEMENT ASSISTANT ADMINISTRATOR

CLASSIFICATION CODE: EXEMPT FULL TIME

DEPARTMENT: QUALITY MANAGEMENT

REPORTS TO: QUALITY MANAGEMENT ADMINISTRATOR

 

STATEMENT OF JOB: Assists in the planning, organizing, preparing for and conducting audits of medical records and clinician credentials adhering to all Federal, State, Tribal laws and regulations, the specific requirements of payor sources, and IHS 638 contracted service; and ensuring compliance to all monitoring and performance measurements. Monitors all electronic records and ensures all documentation is accurate and timely and in compliance with HIPAA, DBHS, AHCCCS standards and federal law. Assists in achieving quality assurance standards by determining system improvements, implementing change and preparing quality assurance documentation.

 

DUTIES AND RESPONSIBILITIES:

  1. Assures the planning operation, integrity, coordination, and quality of services rendered at ABHS meet all applicable laws, rules, and regulations.
  2. Collaboration with ABHS Management and QM Committee to ensure all monitoring of: medical records and clinical documentation, data validation, employee performance/certification is in compliance with all applicable standards and regulations and meets the agency’s missions, goals and strategic planning.
  3. Assists with development of client care and/or process flow indicators/tracking methodology.
  4. Assists with the development of clinical outcome measures, related tracking and monitoring systems and a mechanism integrate efforts into organization-wide Quality Management/Utilization Review processes.
  5. Prepares and submits monthly, quarterly and annual operational reports to the State to provide tracking and trending of data as compared to established goals and objectives.
  6. Assists with the development of Quality Management/Utilization Review plan to indicate areas of weakness/improvements as required by the State.
  7. Manages collection and maintenance of all incident reports including, but not limited to: seclusion, restraint, incident, accident, death and other related safety issues.
  8. Coordinates review/revision of all standards, policy and procedure manuals to ensure timely distribution of all updates.
  9. Direct, coordinates and oversees all regulatory survey activities; develops agenda and meets with and accompanies surveyors.
  10. Directs development of all plans of correction for identified deficiencies.
  11. May act as primary liaison with regulatory/licensing agencies during bi-annual surveys.
  12. Receives and responds to all patient complaints; researches issues for corrective action as appropriate based on findings; escalates physician/provider issues to appropriate parties.
  13. Actively participates in Quality Management Committee; coordinate and acts as facilitator to ensure timely distribution of agenda, adherence to plan and assists in periodic review of charts.
  14. Prepares monthly progress/operational report; identifies areas of improvement, concern and recommendations.
  15. Performs chart review, develops treatment/services plan to meet determined care needs; revises care plan as appropriate.
  16. Performs utilization review of patient chart to ensure compliance with established criteria to maximize reimbursement/coverage of charges.
  17. Performs site visits; performs record review, tours facility, interviews and discusses concerns/issues with staff.
  18. Participates in departmental orientation, on the job training and quality assurance programs/initiatives.
  19. Participates in a variety of department and educational programs to maintain current skill and competency level; identifies and discuss performance or training needs with Supervisor.
  20. Provides positive role model to staff, clients and community partners through leadership, self-discipline, integrity and genuine care for recovery and growth.
  21. Abide by all applicable policies, procedures, and program standards of ABHS, White Mountain Apache Tribe, Indian Health Services, Arizona Health Care Cost Containment System (AHCCCS) and other pertinent regulatory authorities.
  22. Participation in all required ABHS training.
  23. Reports/attends work in timely manner. Must be reliable and communicate directly with supervisor in all matters of attendance.
  24. Other duties as assigned.  

 

KNOWLEDGE, SKILLS AND ABILITIES:

  1. Knowledge of applicable state, federal, licensing and regulatory standards including, but not limited to: IHS, DHS and CMS.
  2. Knowledge of the principles, practices, and methods and techniques of root cause analysis.
  3. Knowledge of the principles, practices, methods and techniques of continuous quality improvement.
  4. Knowledge of the regulations and standards of patient rights.
  5. Knowledge of the principles, practices and methods of utilization review.
  6. Ability to concisely document patient information in a timely manner.
  7. Ability to apply critical thinking and problem solving skills to complex multi-faceted service are for improving efficiencies, operational activities and cost effectiveness.
  8. Ability to positively represent the agency to a variety of audiences.
  9. Ability to utilize effective communication and listening skills to positively influence a variety of audiences.
  10. Ability to utilize effective communication and problem solving skills to effectively identify issues, concerns and interests and provide effective solutions.
  11. Skills in critical thinking and problem solving related to developing integrated strategies.
  12. Ability to regularly change priorities to accomplish tasks with frequent interruptions.
  13. Ability to clearly communicate verbally, read, write, see and hear to perform essential functions.

 

PERFORMANCE STANDARDS:

  • Strictly adheres to the principle of confidentiality.
  • Upholds the vision, mission and values of ABHS while providing high quality, comprehensive and innovative mental health care of Indian people.
  • Understands and follows safety standards in all aspects of performance of the above functions, reports and/or removes unsafe environmental equipment and attends safety education session.
  • ABHS employees are expected to adhere to ABHS’s service standards and organizational values in all their interactions with ABHS clients, other individuals, and fellow employees.
  • Demonstrates commitment to ongoing personal and professional development.
  • Demonstrates professional in all interactions by projecting positive attitude to job, workplace, and others.
  • Performs other job related functions and activities as requested/required.

 

MINIMUM QUALIFICATIONS:

  1. Bachelor’s degree in Social Work, or related field. Minimum of three years of experience working with Tribal entities and experience working with a combination of 638 contracts, ADHS/DBHS and AHCCCS rules and regulations.
  2. Must have clinical and administrative experience with administrative staff, professional and paraprofessional mental health providers.
  3. Must have knowledge and experience in adhering to Federal, State and Tribal laws and regulations pertaining to HIPAA, confidentiality, fraud and abuse, corporate compliance, and all other pertinent laws, regulations and requirements.
  4. Must have ability and experience in medical records management, chart organization, updates, storage and deletion of medical records.
  5. Knowledge of the Arizona Behavioral Health System, and Federal and State regulatory agencies.
  6. Demonstrate critical thinking, problem-solving and organizational and time management skills with ability to work independently, with flexibility within prescribed deadlines.
  7. Microsoft Office proficiency, including familiarity with Adobe software and expert skills with MS Excel.
  8. Valid Arizona Driver’s License and reliable transportation.
  9. Ability to pass all pre-employment testing, including, but not limited to, fingerprint clearance and background check.

 

Preferred:

  1. At least 3 years’ experience working with Native Americans.
  2. Must have a valid driver’s license and reliable transportation.

 

**NOTE: Preference in filling vacancies is given to qualified Indian candidates in accordance with the Indian Preference Act (Title 25, U.S. Code, Section 472 and 473).

 

ESSENTIAL FUNCTIONS

The physical characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of the job.

 

Constant: standing. Frequent: repetitive use of hand, walking, standing, bending neck and waist, squatting, climbing, kneeling, twisting neck and waist, simple grasping of left and right hand, power grasping right and left hand, fine manipulation right and left hand, pushing and pulling right and left hand, reaching above shoulder level, reaching below shoulder level, lifting objects weighing up to 25 pounds from below the waist to a height of 3 feet. 

 

 

Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.  The employment is considered “at will” and agree that employment can be terminated with or without cause and with or without notice at any time at the option of either the employee or the company.