Quality Assurance Risk Management Coordinator

Quality Assurance Risk Management Coordinator

The Quality Assurance Risk Management Coordinator role with the Department of Human Services offers you the chance to make a real impact on behavioral health services across Pennsylvania. This position helps strengthen oversight, improve service quality, and support positive outcomes for individuals who rely on Medicaid behavioral health programs. It is a meaningful career path for someone who wants to support strong systems and better access to care!

This position helps ensure that Medicaid Behavioral Health services are delivered with quality, consistency, and accountability across the Health Choices program. It involves reviewing data, evaluating program practices, and supporting quality improvement efforts. As a Quality Assurance Risk Management Coordinator, you will perform the following duties:

• Compliance Reviews: Review contractor operations and documentation for alignment with state and federal requirements
• Performance Evaluation: Assess quality management plans, evaluations, and program descriptions to confirm benchmarks and standards are met
• Risk Identification: Identify service delivery risks through review of complaints, grievances, and service denial decisions
• Onsite Audits: Lead onsite reviews with program partners to examine service quality, access, and adherence to medical necessity
• Collaboration Work: Coordinate with internal teams and external partners to advance quality initiatives and improve behavioral health outcomes
• Data Reporting: Analyze submissions and prepare written and statistical reports that highlight trends and support decision making

Interested in learning more? Additional details regarding this position can be found in the position description.

Work Schedule and Additional Information:

• Full-time employment
• Work hours are 8:00 AM to 4:30 PM, Monday - Friday, with a 60-minute lunch.
• Telework: You may have the opportunity to work from home (telework) part-time. You will be required to report to 303 Walnut Street Harrisburg, PA 17101, as listed in this posting two days per week. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg.
  
  The ability to telework is subject to change at any time. Additional details may be provided during the interview.
• Salary: In some cases, the starting salary may be non-negotiable.
• You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

Minimum Experience and Training Requirements:

• One year as a Quality Assurance/Risk Management Specialist (Commonwealth job title or equivalent Federal Government job title, as determined by the Office of Administration); 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.

Other Requirements:

• You must meet the PA residency requirement. For more information on ways to meet PA residency requirements, follow the link and click on Residency Guidelines.
• You must be able to perform essential job functions.

How to Apply:

• Resumes, cover letters, and similar documents will not be reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education).
• If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable.
• Your application must be submitted by the posting closing date. Late applications and other required materials will not be accepted.
• Failure to comply with the above application requirements may eliminate you from consideration for this position.
• All application materials and interview responses must reflect the applicant's own experience, qualifications, and work. Applicants may use generative AI tools for preparation purposes only. Use of AI to misrepresent or falsify information, or to assist during interviews, is not permitted. Review the Guidance for Generative AI Tools & Job Seekers for additional information.

Veterans:

• Pennsylvania law (51 Pa. C.S. §7103) provides employment preference for qualified veterans for appointment to many state and local…