A class incumbent is responsible for directing a quality assurance program to include risk management, safety, infection control and utilization review programs for treatment services provided by the Department of Services for Children, Youth and Their Families.
Direct supervision of 1 Medical Records Administrator, indirect supervision of 5 medical records technicians.
Nature and Scope
The class incumbent reports to the Clinical/Accountability Director of the Division of Child Mental Health and is responsible for developing and implementing quality improvement programs for psychiatric and substance abuse treatment at all levels of care such as inpatient services, residential treatment, in-home services, day treatment, outpatient, intake/emergency services and clinical case management. A class incumbent provides consultation and technical assistance to all levels of department staff and to contractors on matters relating to the implementation of quality control and assurance standards. In addition, incumbent monitors and analyzes the quality and appropriateness of department treatment services and contributes to the Departments' managed care system planning. Work also involves developing and conducting educational programs for division staff and contractors in all aspects of quality assurance and acting as liaison with other agencies and external reviewers associated with quality assurance.
Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
Develops and implements quality improvement and risk management programs for services (state-operated and contracted) provided by the Department; prepares written quality improvement plan which describes the process for monitoring quality, appropriateness and timeliness of client care; revises annually each Division's Managed care Quality Improvement Plan to reflect on-going monitoring and tracking of indicators and problems.
Assures the coordination of managed care quality assurance activities with cost recovery efforts (e.g. IV-E or IV-A) standard protocols, assuring basic client and cost information to support the preferred method of recovery on client services.
Performs utilization reviews of Division-specific client managed care activities as it relates to quality of documentation, quality and appropriateness of care to include diagnoses, evaluation and assessments, treatment plans, progress notes, results of diagnostic tests, therapy and client discharge.
Conducts research and review of program activities to provide data needed to assess past/current activities and plan future programmatic changes; conducts analysis and makes recommendations into the Division's program planning efforts.
Maintains schedule of quality assurance activities within each program; gathers and analyzes data through audits, interviews, etc., to monitor quality and appropriateness of services.
Communicates with regulatory and accrediting agencies regarding changes in standards, strategic approaches and program compliance (JCAHO, Medicaid and Licensure of new requirements for programs).
Develops a system to ensure staff are appropriately credentialed for clinical functions performed.
Develops and conducts educational programs for, and provides technical assistance to Department staff and contractors as it relates to quality assurance; identifies areas in which staff/contractor training is needed and obtain/provide training programs in quality assurance for the Department.
Plans, assigns, reviews and evaluates the work of staff.
Serves as chairperson to Department-wide managed care QI/RM/UR committee to ensure that issues and/or problems identified are appropriately addressed.
Prepares a variety of reports for Division Directors and Secretary of the Department.
Knowledge, Skills and Abilities
The intent of the listed knowledge, skills and abilities is to give a general indication of the core requirements for all positions in the class series; therefore, the KSA’s listed are not exhaustive or necessarily inclusive of the requirements of every position in the class.
Knowledge of quality assurance, risk management, utilization management review programs.
Knowledge of principles and practices of management and administration.
Knowledge of principles and practices of supervision.
Knowledge of program planning, evaluation and organizational analysis.
Knowledge of Department programs, policies and procedures.
Knowledge of patient care standards.
Knowledge of State and Federal statutes and JCAHO accreditation standards impacting licensure and health care services.
Knowledge of methods and techniques used in the analysis of managerial and operational problems.
Skill in program analysis and problem-solving techniques.
Ability to analyze program data, make recommendations for and oversee implementation of new/revised programs, policies and/or procedures.
Ability to develop and coordinate training programs.
JOB REQUIREMENTS for Manager of Quality Improvement
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:
Three years experience in quality improvement which includes evaluating the quality of services, identifying problems and needs and recommending corrective action and improvements to ensure optimum service delivery, goals and objectives are met and ensure compliance with applicable laws, rules, regulations and standards.
Three years experience in interpreting licensure, certification and accreditation standards.
Six months experience in health or human services program administration such as overseeing and directing the development, implementation and evaluation of health or human services programs and services; planning and establishing short and long range program goals and objectives. Providing advice to other agency organizational units through consultation.
Six months experience in developing policies and procedures.
Six months experience in staff supervision which includes planning, assigning, reviewing, and evaluating the work of others.