Overview:
CASES is looking for a clinical quality assurance specialist to join the team working with the mental health treatment programs. The ideal candidate is experienced in the standards of care and regulations administered by the New York State Office of Mental Health (OMH), NYC Department of Health and Mental Health (DOHMH), NYS Office of the Medicaid Inspector General (OMIG), Health Insurance Portability and Accountability Act (HIPAA), 42 CFR Part 2 Confidentiality for Substance Use Disorder Treatment, NYS Justice Center for the Protection of People with Special Needs, Health Home Care Management, and Medicaid Managed Care Organizations (MCO). The clinical quality assurance specialist will be experienced in assessment, treatment planning, diagnosis, documentation, incident reporting, person-centered care, and the treatment of people with serious mental illness, co-occurring substance use disorders, and co-morbid medical conditions who experience trauma, and are involved in the criminal legal system.

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What you will be doing:*

• Conduct internal chart review and audits to confirm client records meet standards of care, licensing, medical necessity, State and MCO Medicaid regulations.
• Complete timely utilization review (UR) of client documentation for medical necessity admission and continuing stay, and discharge reasons; develop recommendations shared with managers and monitor how UR decisions are implemented by the treatment team.
• Coordinate and support the incident reporting and review program according to NYS Part 524 regulations, promoting effective staff onboarding and training, engaging and helpful incident review meetings, timely minutes, and follow-up procedures and practices. Ensure incidents are documented, investigated, and appropriately reviewed.
• Support risk management practices for clients with high vulnerability for poor outcomes related to suicide, violence, and medical problems working collaboratively with treatment program managers on quality of care and evidence-based treatment services.
• Conduct continuous quality improvement (CQI) initiatives with treatment program managers to improve program performance and client outcomes.
• Monitor and ensure treatment programs comply with client privacy and release of confidential protected healthcare information, including HIPAA and 42 CFR Part 2 Confidentiality for Substance Use Disorder Treatment.
• Conduct real-time review and approval of documentation that will be shared with criminal legal system stakeholders about client status and progress in treatment.
• Develop and deliver training programs and staff coaching on policies and procedures, documentation, incident reporting, and standards of care to meet the needs of new hires and each treatment program, in compliance with local, state, and federal regulations.
• Demonstrate a commitment to diversity, equity, and inclusion through continuous development and modeling inclusive behaviors.
• Support periodic review and revision of policies and procedures, and updates to the electronic health records Foothold AWARDS and Quali Facts and Care Logic.
• Other duties as assigned by the Director of Quality Improvement.

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What we are looking for:*

• LMSW, LMHC with at least 1 year of quality improvement and compliance experience with NYS licensed treatment programs.
• Maintain a high degree of accuracy along with attention to detail.
• Prioritize assignments and meet stringent deadlines.
• Ability to provide strengths-based constructive feedback, deal with sensitive issues, and maintain confidentiality, all with a focus on improved quality.
• Value diversity, equity, and belonging and contribute to an inclusive work environment.
• Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, and SharePoint).
• Excellent communication, verbal, written, presentation and interpersonal skills.

For more information about CASES benefits please visit: Careers - CASES

Job Type: Full-time

Pay: $60,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work setting:

• In-person

Work Location: In person