Quality System Specialist
The Quality System Specialist (QSS) oversees the various technical and administrative activities supporting the guidelines of the Intensive Utilization Management Program (GAICM). The QSS is the primary link between the GA clinical authorization program and the GAICM Program. QSS are responsible for working with providers and the Program Manager, Regional Coordinators and Recovery Specialists to obtain Releases of Information (ROI), will assign, monitor, and identify cases for movement onto other entitlements. This position will represent ABH® and its services in a positive and professional manner and adhere to ABH®’s best practices, guidelines, policies and procedures as established, promoting ABH® as a leader in behavioral healthcare in all interactions and work.
DUTIES AND RESPONSIBILITIES:
- Identification and Assignment of individuals that meet GAICM program criteria using the ABH® database;
- Review daily list of authorization and forward relevant authorization information to case manager and / or regional coordinator; Track re-admission data on a daily basis and monitor caseloads for connections to lower levels of care and notify Recovery Specialist and Regional Coordinators;
- Track individuals in treatment and contact providers to obtain signed Release of Information;
- Provide telephone support for incoming calls, ensuring prompt voice response to consumers or providers requesting case management services. This support includes answering incoming calls on the ABH® toll-free line; obtaining basic information from the caller and determining the appropriateness of case management services as quickly as possible;
- Pending receipt and registration of appropriate ROI, obtain all available information from ABH® database, , and EMS database; review information to make determination about assignment to Recovery Specialist and recommendations about intervention types and frequency; client assignments will take into consideration such factors as primary location of client, existing caseload distributions of Recovery Specialists, client cultural background, complexity of client’s needs and social risk factors, acuity of client’s symptoms and risk of dangerous behaviors and staff competencies, skill sets, strengths and weakness;
- Responsible for maintaining the master list of client enrollments. In the event of unplanned staff absences or clients moving between regions, the QSS will be responsible to work with Regional Coordinators to assure that clients are moved to the caseload of available staff. The goal is to consistently maintain the continuity of care, regardless of staff availability or client relocation;
- Monitoring recovery specialist’s caseloads and documentation in the RDMS database for timely entering of all client activity notes including screenings and updates on clients service plans;
- Prepare monthly activity reports to determine productivity and activity levels for each client and case manager;
- Prepare other monthly summary reports as requested and produce other reports as required within established time frames;
- Develop and analyze Administrative Reports and make appropriate recommendations to management;
- Attend provider treatment team meetings with the Recovery Specialist, as needed;
- Approve client discharges submitted by Recovery Specialists in RDMS system and verify all necessary documentation is complete and accurate;
- Measure Recovery Specialist outcomes as put forth in ‘GAICM’ proposal;
- Identify clients that may be eligible for movement onto other entitlements and assign the client to Entitlement Specialist;
- Perform duties and assignments related to supporting the Medicare for low income adults in the Behavioral Health Program and maintain familiarity with and understanding of ‘GAICM’ protocols;
- Attend all required staff, supervision and training meetings (held throughoutConnecticut);
- Maintains confidentiality of all client protected health information and adheres to all HIPPA related policies and procedures;
- Demonstrates ethical behavior and cultural sensitivity in all activities involving individuals of diverse backgrounds;
- Performs other tasks/responsibilities as required to support the business operations.
SUPERVISORY DUTIES AND RESPONSIBLITIES:
May be responsible for the supervision of the Recovery Specialist. This includes; but is not limited to establishing and maintaining a working environment conducive to positive morale and teamwork; recruit and hire qualified employees; provide orientation and on-the-job training for staff. Establish short and long term goals that are both measurable and obtainable to meet contract requirements and ensure that these expectations are clearly communicated and understood by all direct and indirect reports. Review and approve all applicable timesheets. Oversee the daily responsibilities of direct reports to ensure that ABH® policies and procedures are being followed and the program/department goals are being met. Provide year-round feedback to employees, counseling, coaching, and training resources and support as necessary. Refer performance concerns/issues to next level Manager & Human Resources Department for advice, next steps and appropriate action. Complete timely staff performance evaluations outlining clearly defining goals/expectations, secure applicable signatures/approvals and process paperwork.
EDUCATION AND EXPERIENCE REQUIREMENTS:
- Master’s level with at least five years of experience in behavioral health care setting required;
- Attends URAC trainings specific to job duties;
- Attends annual Conflict of Interest training.
- Demonstrated leadership, organization and planning skills;
- Strong attention to detail; ability to work on multiple tasks and meet deadlines;
- Excellent PC skills with demonstrated experience using Microsoft Office Package (MS Word, Excel, Power Point, Access, Outlook); internet;
- Strong written and verbal communication skills required.
We are an Equal Opportunity Employer.
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