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- Red Bluff, CA 96080
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Quality Assurance Manager
TEHAMA COUNTY HEALTH SERVICES • Red Bluff, CA
Posted 1 month ago
This position is responsible for managing Quality Assurance Programs within the Health Services Agency to meet state, federal, and local regulations. The incumbent assumes responsibility for quality assurance program development and management including responsibility for the development and implementation of goals, objectives, policies and priorities for all assigned operations and activities. Performance of the work requires the use of considerable independence, initiative, and discretion within established guidelines.
Tehama County Health Services Agency is committed to a healthy community. We provide integrated services to Tehama County residents through education, prevention, assessment, intervention, treatment, and follow up. Our staff are valued for their contributions to client care, whether they work in direct services or are in key support roles. We collaborate, communicate, and support each other so we can focus on what's most important, the overall health of our clients.
Every position is a key position at Health Services. We value input, good communication, and collaboration within our organization as well as with our agency partners. If you would enjoy working with people who are committed to the health of our residents, then our agency would like to hear from you.
Plans, organizes, and performs duties related to Quality Improvement/Assurance Program (QI/QA). | Administers managed care plan activities, audits organizational providers and authorizes out-of-County Medi-Cal utilization. | Develops and provides training to service providers on professional responsibilities, technical skills, quality of care, scope of practice and on issues related to program compliance and integrity. | Assists HSA supervisors to clarify program objectives, fiscal objectives and target populations to be served; provides analysis of the program structures of services system and provides information regarding QA/QI and utilization issues. | Provides feedback to Directors and other management personnel regarding Agency or Division issues pertinent to program compliance for Federal and State standards/regulations and program integrity. | Collaborates with supervisory and administrative staff in formulating policies and procedures, best practices and action plans; makes recommendations for administration of health programs including performance improvement and QI protocols. | Manages activities to meet performance results; audits reports and staff activities to determine compliance to Federal and State performance QI measures. | Reviews medical records; assures that appropriate services are provided; conducts utilization reviews and approves payments for services; assures effective communications. | Assists in development of treatment programs; assesses quality and conformance to Federal, State and other standards. | Assures access to services for eligible clients. | Supervises, coordinates and monitors the activities of the QI/QA/UR programs in order to obtain reimbursement for services and assure effective utilization of Agency resources. | Conducts concurrent reviews of inpatient patient records to assess on-going medical necessity for hospitalization. | Assures thorough review of medical necessity criteria and the appropriate length of authorization for services. | Acts as the liaison with regulatory/reviewing agencies. | Performs Medi-Cal site certification reviews for contract providers. | Confers with physician reviewer and chairs the Pharmacy Review Committee on a regularly scheduled basis and as necessary. | Chairs the Quality Leadership/Quality Improvement Committees. | Reviews current practices to identify opportunities to improve quality; gathers, compiles, maintains, and evaluates data related to staff treatment and charting practices, clinical programs, contractors, services performed, and client/patient feedback. | Develops protocols for the review of inpatient and outpatient services; conducts and/or manages compliance reviews of contractor work-product. | Manages the consumer grievance and appeal process. | Organizes and tracks utilization review, medication support services (monitoring), and peer review in accordance with regulatory requirements. | Ensures compliance with all relevant laws and regulations regarding confidentiality within assigned program areas.
Principles, methods, and procedures of clinical and behavioral health practices | Health care management, health plan administration, government compliance, internal audits and risk management, regulatory affairs and specialty health care consulting | Laws, rules and regulations applicable to medical and behavioral health practices | Principles and methods of management necessary to plan, implement, and evaluate medical and behavioral health practices and programs; to supervise workers; to use independent judgment and discretion in supervision the QI/UM programs | Standards and regulations governing the operation of government behavioral health and medical health facilities | All applicable Federal, State, County, Department, and Division laws, regulations, policies and procedures | Record keeping principles and procedures | Issues of diverse cultures and how they influence practices and program development; principles of supervision, training, education, and team building | Techniques for dealing effectively with and providing a high level of customer service to all individuals contacted in the course of work.
Communicate effectively in written and oral form | Speak effectively in public | Analyze problems, identify solutions, recommend and implement methods, procedures, and techniques for resolution of issues | Assess and prioritize multiple tasks, projects, and demands | Plan, direct, train, supervise and evaluate the work of others | Understand, interpret and apply statutes, regulations and written directions | Pay meticulous attention to detail | Collect and analyze data to identify needs and draw logical conclusions and make appropriate recommendations | Assemble and analyze information and prepare written reports and records in a clear, concise manner | React calmly and professionally in emergency, emotional and/or stressful situations |Organize and prioritize a variety of projects and multiple tasks in an effective and timely manner | Use tact, initiative, prudence and independent judgment within general policy, procedural and legal guidelines | Work independently and as a team member | Make accurate arithmetic, financial and statistical computations | Interact effectively with persons of different social, economic, and ethnic backgrounds
Education, Experience & Licenses
Any combination of training and experience which would provide the required knowledge, skills and abilities is qualifying. A typical way to obtain the required qualifications would be:
- Equivalent to completion of high school (12th grade);
- Graduation from an accredited four-year college or university with a Bachelor's Degree in Nursing or a Master's Degree in Social Work or Psychology; or Doctoral Degree in Clinical Psychology.
- Five years experience in mental health or other related field with increasing responsibilities. Prefer at least one year experience overseeing a mental health program and/or staff in medical or social work setting.
- Requires a valid California driver's license.
- A valid California license to practice as a Registered Nurse; or as a Licensed Clinical Social Worker; or as a Licensed Marriage Family Therapist; or as a Licensed Clinical Psychologist.
- Must complete periodic continuing education coursework as required to maintain active licensure.
- Must possess or be willing to obtain a National Provider Identifier (NPI).
Mobility to work in a standard office setting and use standard office equipment, to operate a motor vehicle and to visit various County and meeting sites. Vision to read printed materials and a computer screen. Hearing and speech to communicate in person, before groups and over the telephone. Standing in work areas and walking between work areas may be required. Finger to access, enter, and retrieve data using a keyboard or calculator and to operate standard office equipment. Occasionally bend, stoop, kneel, reach, push, and pulldrawers open and closed to retrieve and file information. Must possess the ability to lift, carry, push, and pullmaterials and objects, up to 30 pounds, as necessary to perform job functions.
Employees work in an office environment with moderate noise levels, controlled temperature conditions, and no direct exposure to hazardous physical substances. Employees may interact with upset staff and/or public and private representatives in interpreting and enforcing departmental policies and procedures.
In addition, Tehama County is establishing an eligibility list to fill future vacancies for a Quality Assurance Manager, as well as subsequent vacancies which occur during the life of the eligibility list.
If you have questions about this recruitment, please contact the department at the phone number listed below.
EQUAL OPPORTUNITY EMPLOYER / AMERICANS WITH DISABILITIES ACT COMPLIANT / VETERANS' PREFERENCE POLICY / DRUG-FREE WORKPLACE