Quality Assurance Specialist- Audit

Summary:

The Quality Assurance Specialist is responsible for ensuring services provided meet the established standards of quality in the domains of CCO/HH Care Coordination, customer satisfaction, and policy and procedure development. This role supports the operationalization and success of Prime Care Coordination’s holistic Quality Management Program.

Essential Job Functions

Conduct audits in alignment with organizational policies and regulatory requirements and document internal audits and other quality improvement activities.
Issue audit findings via electronic record and complete validations to ensure implementation of corrective actions.
Support monitoring risk management activities.
Assist with developing, maintaining, and distributing reports on quality to include audit findings and analysis of trends, patterns, and potential quality improvement opportunities.
Assist with devising sampling procedures and directions for recording and reporting quality data.
Assist with the development, audit, and reporting of the Quality Management Program and all of its components.
Collect, compile, and analyze statistical quality data to identify areas for improvement in the quality system.
Support in developing, recommending, and monitoring corrective and preventive actions.
Identify training needs and organize training interventions to meet quality standards.
Interpret and implement quality improvement standards and procedures.
Assist with evaluating adequacy of quality improvement standards.
Ensure compliance with all federal/state laws and regulations, including affirmative action plan compliance.
Assist with drafting and maintaining policies, procedures, and standard operating procedures related to quality and compliance.
Ensure audit findings and corrective actions are documented in accordance with regulatory and organizational documentation standards.
Perform any other related duties as required by supervisor.
Knowledge, Skills, and Abilities

Knowledge of OPWDD and/or DOH regulations, programs, and service delivery systems including Medicaid Service Coordination, Care Coordination, Managed Care, Health Home Care Management and/or services for people with intellectual and developmental disabilities
Knowledge of audit, policy / procedures, quality assurance regulations.
Knowledge of OPWDD Part 624 & 625 Regulations, preferred
Must be able to multi-task, establish priorities, and meet deadlines.
Must demonstrate attention to detail, planning and organizational skills.
Ability to work in a collaborative environment, work independently, and motivate others.
Ability to communicate effectively, both orally and in writing.
Ability to act quickly, assess, and act appropriately in crisis situations
Proficient with technology and understanding of health records
Data collection, management and analysis skills required
Maintain appropriate confidentiality and discretion at all times.

Education and Experience:

Bachelor’s Degree in Healthcare, Business, Human Services Administration, or related field, preferred.
Minimum 2 years of experience within a health care or human services setting.
Possession of valid, unrestricted NYS driver’s license required
All experience and education requirements, except when required by federal, state, or local laws or requirements, may be waived at the discretion of management with the approval of the Executive Director, in collaboration with Human Resources.

Physical Requirements /

Working Conditions:

Ability to sit continuously.
Ability to reach above shoulder level.
Ability to turn/twist upper body.
Ability to use hand for repetitive action and fine manipulating for the purpose of keyboarding.
Must be able to travel throughout covered territories in Upstate NY as needed.

Corporate Qualifications/Expectations:

Adhere to all Prime Care Coordination policies and procedures.
Adhere to the Agency Mission, Vision, Shared Values, and Customer Service Standards.
Attend mandatory education and training modules as scheduled; obtain and maintain required certifications/training by State regulations and PCC policy.
Act as a professional representative of PCC in regard to appearance, behavior, temperament, communication,…