POSITION SUMMARY

Reporting to the Director of Quality Management, the Quality Management Coordinator is responsible for managing the functions of quality assurance/quality improvement, data collection and reporting, and monitoring the utilization management for each program. Leads and ensures adherence & compliance with CARF and county contracts, takes the lead in partnership with the QM Director to support new program implementation, and assists with the monitoring of clinical services to assure minimum quality standards and continuous quality improvement.

Takes in lead role in partnership with Program Directors and the Quality Management Director for external audits, responds to DHCS & county Audits and Correction Action Plans, Participates and facilitates in the absence of Quality Assurance Clinicians/Specialist the monthly QI/H&S meetings for programs, identifies program compliances needs and works to close gaps, assists in pulling grant data, attends county meetings, assists with policy and procedure updates, Supports QA Clinicians to submit county reports, ensures the Medi-Cal trackers are weekly, provides EHR and clinical documentation training, and reviews the Census Reports.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Oversee, lead, document, and facilitate QR related meetings (QI, QRSUR, Health & Safety).
• Assign patient records to be audited for QRSUR
• Responsible for ensuring auditing of 10% of the QRSUR patient records.
• Train staff on using the auditing tool for peer audits as needed
• Train staff on chart documentation updates and improvements.
• Calculate the QRSUR results and review final results with the QRSUR committee, present audit trends at QIC monthly.
• In partnership with Quality Management Director, maintain up to date with CARF standards to ensure that programs are adhering to the minimum requirements for accreditation.
• Evaluates the quality of services provided compared to clinical best practice guidelines.
• In collaboration with the Director of Quality Management and Privacy Officer, takes the lead to ensure the QA Clinicians/specialist complete the Quarterly QR audits.
• Responsible for collecting, tracking and auditing program's grievances to ensure timely resolution of client complaints. Present grievance trends and areas of improvement during monthly QIC meetings.
• Develops and monitors clinical and administrative processes to assure the quality of care and regulatory compliance.
• Provides support with monitoring county data entry systems (i.e. AVATAR, IRIS, Sage, etc.) to ensure timely entry of CalOMS, authorizations, appeals, etc.
• Lead county utilization review audits and support with responding to Corrective Action Plans.
• Plans and provides EHR (Welligent/Exym) specific training for staff
• Assesses compliance with record-keeping standards, appropriateness of services provided, and/or determines the need for additional services.
• Performs a variety of complex and independent activities involved in the collection, analysis, documentation, and interpretation of data related to quality improvement. Creates monthly reports and quarterly reporting for QIC and as needed for grants or other reporting.
• Evaluate and interpret collected data and prepare written reports and analyses setting forth progress, adverse trends, and appropriate recommendations or conclusions to ensure continuous quality improvement.
• Collaborate with billing for the resolve of billing violations to ensure proper resolution.
• Meets regularly with multi-disciplinary team members concerning client and program issues; assists in the development or modification of procedures for improvement of services.
• Develops forms and procedures to track and compile information and apply appropriate data analysis techniques to maintain tracking statistics.
• In partnership with the Quality Management Director, maintains liaison with other provider agencies' Quality Assurance, Utilization Review, and Risk Management offices as well as related administrative departments; represent Phoenix House on various quality audit and review committees.
• Stays abreast of new developments in the field of Quality Assurance / Improvement as related to mental health/SUD, recommend new policies, and revise existing policies/procedures for compliance with all applicable laws and standards.
• Leads or participates in other projects as assigned.
• May assists in the preparation of grant proposals.
• Analyzes and recommends positions on policy/procedural/clinical issues, and proposals.
• Consults regarding case/issue specific clinical questions.
• Maintains provider relations.
• Represents Phoenix House at meetings, training events, and conferences.
• Provides technical assistance and consultation to clinicians.
• Ensures compliance with local, state, and federal confidentiality laws and regulations.
• Attends all required staff training sessions in accordance with Phoenix House and state licensing requirements, completes all training on time
• Attends and participates in program and all staff meetings.
• Adheres to and promotes the Phoenix House Mission, Vision, and Values while acting as a role model for others.
• Completes records requests in the absence of Quality Assurance Clinicians/Specialist.
• In collaboration with the Director of Quality Management, takes the lead on collecting data and preparing the monthly QIC presentation and conducts the QIC presentation in the absence of the Director of Quality Management.
• Other duties as assigned.

EDUCATION/EXPERIENCE/CREDENTIALS

The Quality Management Coordinator shall possess a

• Bachelor's degree in a related field Required
• Three (3) to Five (5) years administrative experience required
• Experience in Substance Abuse or Mental Health preferred
• Experience with DMC-ODS, CalAIM, SAPC, DMH, Community Care Licensing, and other governing bodies preferred
• Must maintain a valid California Drivers' License, have proof of automobile insurance and maintain a safe driving record based on Phoenix House policy

KNOWLEDGE, SKILLS, AND ABILITIES

• Demonstrated commitment and adherence to Phoenix House Mission, Vision, and Values: I CARE For: Integrity, Collaboration Appreciation, Respect, Excellence, and Forward-Thinking Proficiency in MS Office systems
• Ability to utilize an electronic healthcare record
• Experience and ability to collect and analyze data for continuous improvement reporting.
• Experience with reporting and data analysis software.
• Establish and maintain effective working relationships with others
• Communicate effectively with others both orally and in writing
• Ability to work effectively in a fast-paced changing environment
• Ability to establish and consistently enforce appropriate boundaries with patients
• Ability to model positive behavior and demeanor
• Understanding of addiction, co-occurring models, and treatment modalities
• Understanding of patient development and family systems
• General understanding of the residential medical model of treatment, SUD treatment practices, group facilitation utilizing Evidenced Based Treatments and continuing care practices that lead to successful discharge transitions for all assigned patients
• Excellent time management and organizational skill
• Strong crisis management, conflict resolution, and de-escalation skills.
• Ability to be flexible; problem solver, self-directed; customer service-oriented, and collaborative
• Skills and ability to engage and develop a rapport with patients and families of various backgrounds