Behavioral Health Quality Assurance Specialist

Full-Time
Monday – Friday 8:30 – 5:00
Salary $75,000 – 95,000
Licenses: Current CA Licensed LMFT, LCSW, LPCC

As the Behavioral Health Quality Assurance Specialist, you will monitor compliance in the Behavioral Health department through audits, checklists, and continuous quality improvements. The Quality Assurance Specialist maintains current information on clinical practice guidelines, health tech assessments, research studies, policies, and recommendations for expert behavioral health testimony; maintains a policy library; develops, coordinates, and implements testing and quality assurance measures and activities; monitors testing and quality assurance policies, processes, and procedures; and prepares and submits reports and deliverables on time as required. Design, develop and oversee all quality monitoring activities and auditing of client charts, notes, intakes, and assessments. Provide quality measures and how they apply to the various Behavioral Health department and act as an operational compliance monitor for the Behavioral Health department. Work closely with and in consultation with the Behavioral Health Chief Clinical Officer and directors. Troubleshoots clinical trials and activities. Support overall consistency, thoroughness, and accuracy of the with the California Mental Health Services Authority (CalMHSA).

Responsibilities:
Plans, coordinates, and directs quality assurance programs designed to ensure continuous quality of care consistent with established standards and customer requirements and expectations.
Oversees and facilitates all QA activities, provides a continuous improvement, consulting services to internal staff to increase knowledge of performance improvement, strategies, principles, methodology, techniques, and data analysis.
Ensure that all processes contributing to the performance of a clinical trial are conducted properly.
Ensures accurate clinical reviews and determinations through accurate assessment of the patient, relevant evaluations, and collateral sources of individuals.
Establishes key performance indicators and maintains systems for tracking, reporting, and improving performance.
Reviews audit results and identifies the severity of findings or the risk associated with the findings to ensure the appropriate level of action is taken to eliminate non-conformance.
Tracks or follows up on corrective action plans to ensure completion of all items in the specified time frame.
Review and evaluate reported crisis (i.e., highly urgent service-related problem with immediate negative implications for the Company) and formulate a plan of action for handling the incident/issues based on the area of expertise/responsibility.
Attends and actively participates in staff meetings and conducts case consultations/peer reviews/internal auditing.
Performs ongoing reassessment of the review process to offer opportunities for improvement and/or change.
Facilitates and supports Stakeholder Advisory Councils.
Utilizes measurable indicators and outcome measurements to determine whether the desired organizational results are achieved.
Consistent reviewing clinical notes for timely completion, medical necessity, and meeting the standard of care.

Required Qualifications

A masters’ Degree in Psychology or Social Work-related health care discipline is required.
Ability to work independently, exercise good judgment, perform clerical work in a methodical independent manner with speed and accuracy.
Ability to provide information in verbal and written form professionally
Knowledge of quality improvement techniques and evidenced-based practices preferred
Experience in project management, program evaluation, team facilitation, and analysis preferred
Experience in Behavioral Health programs, healthcare field, or health plan quality management, data analytics, public health, or closely related field preferred
Ability to determine a clinical diagnosis accounting for psychological and behavioral issues.
Ability to utilize computer equipment and web-based software to conduct work.
Ability to interact with the various office staff as needed to support necessary workflows.
Ability to interact with healthcare professionals, patients, their families, and other supports.
Ability to communicate effectively to individuals and groups through spoken, written, and electronic media.
Ability to attend to detail, effectively prioritize and execute tasks in a timely manner.

Experience

Minimum of 2 years of Quality Assurance experience in a Behavioral health-related field.
Experience in auditing and reviewing clinical notes.
knowledge and experience of psychiatric disorders, symptoms, diagnoses, and criteria as defined by the most current Diagnostic and Statistical DSM 5 manual in California. Quality management and/or compliance experience required.
Experience identifying organizational needs and recommending the appropriate improvements to increase organizational effectiveness.
Knowledge of Parity in Mental Health
Knowledge of insurance programs with relevant experience navigating similar complex projects.
Knowledge of standards of practice related to the determination of Level of Care.
Knowledge of standards of practice related to mental health and other disorders typically requiring psychiatric inpatient.
Knowledge and understanding of public sector services and supports.
Computer proficiency in Microsoft Excel, Word, PowerPoint, Teams, google docs, EHR, and Outlook.
Ability to determine a clinical diagnosis accounting for psychological and behavioral issues, utilize computer equipment and web-based software to conduct work, interact with the various office staff as needed to support necessary workflows, interact with healthcare professionals, patients, their families, and other support systems, communicate effectively with individuals and groups through spoken, written, and electronic media.
Ability to attend to detail, effectively prioritize and execute tasks in a timely manner.