Quality Improvement Specialist - Media, PA

POSITION SUMMARY: The Quality Improvement Coordinator conducts internal evaluations of services to ensure quality care which fulfills all regulatory, funding agency, and internal standards; performs assessments of all services and make recommendations for improvement in all aspects of service delivery; and develops and implements policies for assuring compliance with all fire, health, safetys and security regulations.

DUTIES AND RESPONSIBILITIES:

• Conduct internal evaluations for the assigned Adult Behavioral Health programs including, but not limited to:
  
  
  
  • Self-initiate Quality Improvement (QI) and Quality Assurance (QA) projects to aid in Elwyn's on-going commitment to the delivery of exceptional services as indicated through internal evaluations
  • Conduct reviews/audits of program plans and related documents for compliance with professional quality and regulatory standards
  • Conduct chart audits to ensure quality of services delivered to clients and compliance with Managed Care Organization (MCO) policies as well as to ensure compliance with licensing regulations
  • Present chart audit findings or other relevant information to program leadership on a monthly basis, as a summary email, requesting in-person or virtual meetings based on findings, as needed
  • Create effective internal control procedures based on audit findings
  • Report Quality Improvement needs to the Director of QI based on internal evaluations, and chart audits, providing recommendations for process improvement
  • Evaluate all aspects of programming and ensure all policies and procedures are followed and enforced
  
  
  
  
• Obtain and maintain current Certified Investigator (CI) training and credentialing
• Complete investigations of incidents, as assigned, with tasks including but not limited to interviewing complainant, witnesses, and targets; visit site for investigation inspections; review any collateral records as indicated; preserve all evidence and maintain appropriate chain of custody; author comprehensive report of all investigation findings; and facilitate investigation debriefing and wrap-up with program leadership and Human Resources
• Develop, implement, and monitor plans of correction as assigned; assist the QI Director with building processes and systems to prevent recurrence of identified issues
• Participate in the development of policies and procedures regarding utilization management, facility safety, and fire safety, in cooperation with the Director of QI and program leadership, based on Office of Mental Health and Substance Abuse Services (OMHSAS) standards
• Attend Elwyn and community-based committees and sub-committees, as assigned, looking for opportunities for process and policy improvement for the programs supported
• Conduct interviews and surveys with individuals supported, their families/guardians, staff members, advocates, etc. to verify that quality services are being delivered, and the program is meeting customer needs
• Provide in-service trainings for all Adult Behavioral Health staff to support compliance, program development, and thorough understanding of all program regulations
• Answer all questions regarding forms, policies, and protocols in regards to the annual program plan writing, implementation, revision, and training
• Maintain records of all compliance documentation and survey results as required under policy
• Maintain confidential program staff credentialing files and training records at the program location, under lock and key
• Run and review training reports using the Elwyn computer database to make sure staff are compliant and up to date on all required trainings based on program regulations
• Support registration and scheduling of Elwyn staff and other third-party support resources for Elwyn training (eLMS), in cooperation with Elwyn Learning & Staffing Development, and the Clinical Coordinator; provide reports of missed trainings to Director of QI and program leadership to ensure trainings are completed, to maintain compliance, and to maintain exceptional resident care
• Determine, by a monthly review of the exclusion list database, if Elwyn employees are noted; conduct due diligence based on any employees found on the list (e.g. coordinate with Risk Management and Human Resources, meet with the employee)
• Review, update, and maintain a current file of all QI tools used as part of continuous quality improvement (CQI), including but not limited to tools for chart, medication audit, physical site, finance, and data audits
• Maintain up-to-date knowledge of all regulations and MCO policies through participation in external training offerings and review of regulatory body communications, communicating changes to the program, and keeping all programming policies and procedures current; maintain a current file of all program regulatory standards and updates
• Monitor program compliance with federal, state, local, and managed care organization's (MCO) regulations as applicable, reporting any deficiencies to the Director
• Compare treatment notes to billing records, on a monthly basis at minimum, to verify time spent on each case for billing to payers
• Enter information concerning incidents in the current incident management system for reporting and analysis purposes
• Perform cardiopulmonary resuscitation (CPR), first aid, and crisis intervention using agency-trained protocols
• Perform other duties as assigned

IMMEDIATE SUPERVISOR: Director of Quality Improvement

DIRECT REPORTS: None

CONTACTS: Elwyn clients and staff, families/guardians; county and state agency regulators, representatives and vendors, federal, state, regional, county and local agency personnel and visitors.

EDUCATION/EXPERIENCE/SKILLS REQUIREMENTS:

• High school diploma or graduate equivalency diploma (GED) with five (5) years' experience in human service or healthcare administration OR associate degree in human services, healthcare administration, nursing, social work, psychology, or other related field with a minimum of three (3) years in human services or healthcare administration; bachelor's degree with three (3) years in human services or healthcare administration preferred, Masters in Social Work (MSW), highly desired
• Experience in the area of healthcare compliance preferred
• Current Pennsylvania Certified Investigator certification preferred
• Demonstrated ability to work effectively as part of a team
• Ability to work in a fast-paced environment and manage and prioritize multiple, often competing, priorities
• Demonstrated strong attention to detail
• Demonstrated strong time management and organizational skills
• Demonstrated excellent judgment with the ability to independently solve problems and make decisions with little or no need for direct supervision
• Demonstrated ability to anticipate future needed changes or identify problem areas and take effective actions
• Must be able to perform CPR, first aid, and crisis intervention using agency-trained protocols
• Demonstrated intermediate experience with Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint; report-writer experience preferred
• Experience in the use of electronic databases including but not limited to National Provider Identifier (NPI), learning management systems, Human Resources Information Systems (HRIS), and the county billing system
• Knowledge of Electronic Health Record (EHR) / Electronic Medical Record (EMR) preferred
• Must have current, valid driver's license in state of residence, three (3) years driving experience in the United States, and acceptable driving record

PHYSICAL DEMANDS/ENVIRONMENTAL PROFILE: See Physical Demands Checklist below which represents the general physical demands and environment conditions to which the employee holding this position must meet, in addition to the duties and responsibilities listed above, to successfully perform the essential functions of this job. Elwyn will engage otherwise qualified candidates for this position whose disabilities may require reasonable accommodations to enable an individual to perform the essential functions.

Elwyn reserves the right to revise or change job duties and responsibilities as needed. This job description is not intended to be an all-inclusive statement of duties and responsibilities of the job nor does it constitute a written or implied contract.

Elwyn is an Equal Opportunity Employer. Elwyn does not discriminate on the basis of race, color, religion, creed, ancestry, pregnancy status, medical condition, gender, gender identity or expression, genetic information, sexual orientation or identity, age, national origin, citizenship, handicap status, marital or family status, mental or physical disability, perceived disability, military or veteran status, political activities or affiliations, or any other characteristic protected under applicable federal, state or local law, ordinance, or regulation.