FBH Clinical Quality Manager

Overview

FBH CLINICAL Quality Manager

Tukwila, WA

OPPORTUNITY FOR INTERNAL APPLICANTS ONLY

Catholic Community Services, Family Behavioral Health is looking for a Clinical Quality Manager. Our teams provide individualized, creative and flexible services, infused with evidence-based and evidence-informed strategies.WHO WE ARE: 

We are a values-driven organization, providing family-oriented behavioral health care for children, youth and families, provided primarily in their own home and community. Our enthusiastic clinical teams provide whatever is needed to help children and youth remain safely in their own home with their family, restoring hope, providing intense mental health services and supports, and helping to strengthen the family unity. With sites located in Tukwila, Burien, North Tacoma, University Place, Olympia, Shelton, Bremerton, Aberdeen, Yelm, Vancouver, (Salmon Creek and Oakview Drive) and Portland Oregon, we offer comprehensive intensive, Wrap-around mental health services to a diverse population for youth and families. We employ almost 800 energetic and compassionate employees.

WHAT WE VALUE: Compassion Diversity Strength-Based-Approach Social-Justice & Our Staff!

WHAT WE OFFER: 

• Starting Salary range: $99,750.14 - $114,712.67

BENEFITS:

• 12 paid holidays; plus 1 personal holiday each year!
• 3 weeks' vacation per year
• 12 sick days per year
• Medical
• Dental
• Vision Insurance
• Life Insurance
• Retirement Plans: 403-B Employee Savings Plan and an Employer Contribution Pension 
• The Clinical CQI Manager works in partnership with the FBH System CQI Team, the FBH Administrative Unit, the Site Director and Site Leadership Team to develop and manage effective systems to ensure the highest possible Standards of Care and Compliance for all Behavioral Health Treatment services provided by the site (including Child Welfare when applicable).
• The Site Director maintains overall responsibility for all clinical and operational activities within the site, however the day-to-day and direct oversight pertaining to compliance is the responsibility of the Clinical CQI Manager. Working in tandem with the Site Director, the Clinical CQI Manager bears direct responsibility for ensuring compliance to the best of his or her ability with Federal Medicaid regulations, State laws and regulations, contract requirements and deliverables, Behavioral Health Organization (BHO) mandates and requirements, MCO’s (Managed Care Organizations) as well as adherence to CCSWW Policies and Procedures, FBH Policies and Procedures and local requirements.  Should the Clinical CQI Manager become aware of a significant issue pertaining to compliance, he or she notifies the Site Director and the two work in tandem to develop strategies to bring about solutions. 
• As the site moves into full Healthcare Integration, the Clinical CQI Manager and Site Director work closely with the FBH Director of Business Operations and FBH Vice-President to complete transitions to behavioral healthcare contracts with Managed Care Organizations (MCOs) and incorporate the additional regulatory compliance standards.
• This position carries substantial responsibility, assisting and training staff to develop competency in documentation requirements and standards. Failures in Medicaid Compliance and all other regulatory arenas result in substantial consequences for the organization, which may include financial penalties to the FBH System, or suspension of State Behavioral Health Licensure for the organization. The Clinical CQI Manager is often the individual in leadership closest to the clinical documentation, and most able to identify strategies and solutions to mitigate risk at the earliest possible juncture.  As such, this position is essential in diminishing significant risk to the organization.
• This position is a member of the site leadership team and works collaboratively with the team in enthusiastically promoting the values, Guiding Principles and goals of the Family Behavioral Health System. He or she is responsible for providing operational and administrative systems leadership and support to the Site Director, Clinical Supervisors and all direct service operations staff.

Responsibilities

JOB SUMMARY: 

Compliance, Contracts and Documentation Oversight;

• Through oversight of direct reports in Operations, confirm SERI reporting instructions are employed to ensure medical/Behavioral Health encounters are coded in accordance with medical coding guidelines and that specific data elements (e.g. specific description of each encounter, staff education requirements are met, timeframes meet SERI requirements, etc.) are complete, as required for encounter submission in each BHO or MCO. Concurrently, ensure medical coding is consistent with the BHO or MCO Data Dictionary in WA and HealthShares MCO in OR.
• Train staff to ensure ongoing proficiency with medical CPT (Current Procedural Terminology) Codes and HCPCS (Healthcare Common Procedure Coding System) Codes for direct submission and encounter reporting through Electronic Health Records (EHR’s) to the Behavioral Health Organization (BHO), Managed Care Organization (MCO), and subsequently the State Department of Behavioral Health Resources (DBHR) and the state Health Care Administration (HCA) in WA, as well as HealthShares MCO in Oregon.
• Conduct spontaneous and random clinical record reviews to ensure medical necessity is met and is current, and that content, format, timeliness, compliance and quality standards of documentation are maintained.

• Take the lead in site preparation for the following; Federal, State, and county audits, Behavioral Health Organization audits, Managed Care Organization audits and External Quality Review Organization audits (EQRO). This will include working closely well in advance of audits with any staff member struggling with timeliness or compliance issues in documentation.
• Notify CQI System Implementation Specialist (Stephanie Thelen), FBH Vice-President and Clinical/System Director immediately when notice of audits is received for the site. Audits will include inspection and scoring of behavioral and medical (psychiatric) charts, encounter billings, personnel files, audits of FBH Policies and Procedures, physical site requirement audits and reviews of all additional Policies and Procedures (e.g. CCSWW P&Ps, and HR P&Ps) as well as audits of Human Resources files.  As such, site preparation is relatively complex and must be attended to on an ongoing basis. 
• The CCQI Manager is present and involved in all audits and site visits, to whatever extent is allowed by reviewers. As some auditors may be present on site for a week or more, adjust work schedule to the extent possible in order to be available to reviewers.
• Prepare written responses to corrective actions as needed, and submit the audit response to the Site Director in a timely manner. Following Site Director approval, submit the report to the appropriate regulatory authority. 
• Work in concert with the Site Leadership Team to implement all corrective actions and monitor their effectiveness.
• Coordinate with the FBH System CQI Team (CQI Director, System Implementation Specialist and System Implementation Analyst) to ensure staff and leadership are aware of scheduled Site Reviews conducted twice yearly by the the FBH System CQI Team. As Clinical Supervisors and other Site Leadership are required participate directly with the CQI Team during scheduled chart reviews once yearly at a minimum, advance notice to site leadership of FBH reviews is encouraged. 
• Upon receipt of scored reports and corrective actions, work together with the Site Director and Clinical Supervisors to develop corrective strategies. Submit any response requested by CQI Team and implement corrective strategies as appropriate.
  • Maintain familiarity with current Federal and State Medicaid requirements pertaining to Behavioral Health Treatment and Documentation Mandates.
  • Develop and maintain proficiency in the DSHS Service Encounter Reporting Instructions (SERI) for BHO’s.
  • Develop familiarity with the Data Dictionary(s) for each BHO and/or MCO with whom the Site contracts.
  • Review BHO error reports to assess staff competency re data accuracy. Review data reports within the FBH EHR PsychConsult as well as the BHO EHR. Work closely with the FBH Administrative Unit to confirm that data errors are corrected in a timely manner and that the corrections are acceptable.
  • Assist staff in competency development with respect to documentation requirements and standards. On a quarterly basis, assess clinical/direct service staff competency through chart reviews. Identify staff in need of re-training, notify clinical supervisors and arrange for re-training as needed.
  • Directly engage staff in the enforcement of standards and help staff understand reasons behind requirements, (and particularly changes in requirements beyond our control) whenever possible.
  • Assist Clinical and Operations staff to understand the mutual dependency between clinical treatment teams and operations teams, and assist the two entities to work in tandem with one another, as the functions and requirements carry equal importance in provision of behavioral health treatment.
  • Provide or ensure provision of federally required Medicaid Fraud and Abuse training annually, or more frequently if needed.
    • Implement protocols as needed pertaining to the medical administrative functions of the office including development and maintenance of required documents, compliance with security requirements for clinical and medical records, and record redaction as needed by court order.
  • Work in tandem with the System Implementation Specialist (Stephanie Thelen) to ensure clinical and administrative Contract Deliverables are met and submitted in accordance with specified contract requirements and timeframes.

Accreditation:

• Lead the site in readiness for CARF accreditation working closely with the FBH CQI Team, completing survey preparation documents for the site and ensuring standards are met.
• Actively participate in CARF Survey visit.
• Prepare any needed responses following the CARF Survey and submit to Site Director for approval.
• Following accreditation, continue educating current and new staff with respect to CARF Standards.
• Develop strategies to monitor compliance with CARF standards on an ongoing basis.

Grievance Reporting:

• Track incidents, complaints and grievances for the site and prepare reports to submit to the BHO(s), MCO’s and state entities as required (DBHR and HCA).
• Work with site leadership in analyzing and recommending action in response to grievances, trends and findings. Alert Site Director, FBH Clinical Director and System Director to trends or issues encompassing risk to those we serve, risk to staff, etc.  In addition, immediately report serious grievances, or to multiple grievances (more than one) pertaining to any specific staff member to the Site Director.

Clinical Quality Oversight

• Maintain proficiency in determination of diagnostic Medical Necessity (per Medicaid) for initial and ongoing service authorization. Identify those interventions that have stabilized to the extent that support for continued Medical Necessity is insufficient. After ensuring this is not an issue related to incomplete documentation, refer for Transition Review by the associated Clinical Supervisor and FBH Child and Family Team.  
• Review service intensity through PsychConsult (FBH EHR) to track interventions that may be appropriate for transition. Notify Clinical Supervisors and the Site Director of interventions with ongoing intensity that is not consistent with intensive service provision. 
• Implement effective Utilization Management processes to ensure that clinical necessity for admission; continued treatment; and service closure comply with contractual, regulatory and Family Behavioral Health System
• Monitor the WISe (Wraparound with Intensive Services) “wait list”. Work to ensure service Transitions occur as expediently as appropriate so that those ‘in-waiting’ receive services at the earliest possible juncture. Meet state Access to Care requirements.
• Ensure Psychiatric services are available and provided within the site, and that all related operations are well organized and efficient. Ensure systems are in place to minimize ‘no-shows’ (e.g. Psychiatric Care Coordinator calls with appointment reminders, Clinician arranges help with transportation, etc.). 
• Provide day-to-day supervision of the Psychiatric Care Coordinator and oversight of all operational protocol pertaining to psychiatric care in the site (scheduling, prescription formularies through the various MCOs, emergency psychiatric appointments, etc.).
• Through active partnership with site and system leadership assist and encourage direct service staff to employ Collaborative Documentation, and to utilize documentation as a clinical tool.
• As with all FBH Staff and Leadership, maintain an overall “risk awareness” remaining alert to any potential risks and notify Site Director immediately in order to prevent and/or mitigate problematic situations.

Manage daily Service Operations, Processes and Procedures;

• Serve as the site representative to FBH System Operations Team and CCSWW Systems regarding administrative issues (Human Resources, Accounting, Information technology, Management Information Systems, contract management, Medicaid compliance, etc.).
• Directly supervise the Site Operations Team, including oversight of all activities completed by direct reports; e.g. Medicaid Encounter entries into the FBH EHR, and EHR’s for BHOs, MCOs and State DBHR and HCA, site-based chart reviews, monitoring of service access timeframes, service intensity reports, transitions, and multiple data reports as needed.
• Through daily supervision, create a cooperative and positive culture throughout the Operations Team to support the objectives of the site and the work of the Clinical Teams.
• Evaluate and adjust strategies to accomplish the work of the site – anticipating staff needs and maintaining a future orientation in a complex and rapidly changing environment.
• Maintain calm and reassuring communications with staff, even as ever-changing Federal, State MCO and BHO requirements create challenges and/or FBH and organizational changes occur. It is our responsibility in Leadership to work through complexities together, ‘buffering’ direct service staff whenever possible so that they can focus on provision of behavioral health treatment and services.
• Utilize PsychConsult and other EHR’s as appropriate to query, process, analyze data and automate reports to assist Site Director and other Site Leadership. Present findings of analysis to clinical and administrative groups as requested by Site Director.
• Collaborate with Site Director and FBH Clinical and/or VP/System Director regarding breach of Protected Health Information including notification and tracking.

Technology and Facilities

• Manage building maintenance and improvements, including: liaison with landlord representatives, ensure compliance with fire codes and ADA requirements; monitor janitorial service.
• Maintain building security, including maintaining and issuing keys and training staff during new hire orientation on building access and safety.
• Supervise staff working with Information Technology on hardware and connectivity issues. May perform certain IT tasks following their instruction.

This position will be based out of our Tukwila, WA site. 

A full job description may be shared with candidates invited for an interview

Qualifications

WHAT WE ARE SEEKING IN A CANDIDATE:

• Master’s degree in Social Services, or related field. A Bachelor’s degree in the field with a Master’s in a position such as Organizational Management may be substituted.
• Two or more years’ experience in a progressively responsible Clinical and/or Behavioral Health Operations position.
• Knowledge of applicable laws, contracts, administrative codes and other regulations.
• Knowledge of quality improvement strategies, principles and practice approaches.
• Excellent interpersonal and organizational skills with the ability to communicate respectfully with families and professionals.
• Committed to maintaining an optimistic, solution-focused and strength-based approach in all aspects – with respect to those we serve as well as relationships with colleagues.
• Computer skills with experience with Microsoft Word, Excel, and Access.
• Excellent written and oral communication skills.
• First/Aid CPR certified or the ability to become certified within the 1 month of employment
• Applicant must successfully pass required background checks prior to an offer of
• Ability to work independently in addition to working as a member of a
• Demonstrates the necessary attitudes, knowledge and skills to deliver culturally competent services and work effectively in multi-cultural
• Support and uphold the mission, beliefs and values of Catholic Community Services and Catholic Housing.  

PREFERRED QUALIFICATIONS:

• Experience working in a private non-profit system.
• Designated by the state organizational licensing authority as a Mental Health Professional (MHP - Washington) or Qualified Mental Health Professional (QMHP – Oregon), or meets qualifications for such.
• Experience in provision of Wraparound or Intensive Behavioral Health Services

EMPLOYEE PLEDGE:

We will not tolerate attitudes, behaviors, or statements that alienate, offend, or injure any person associated with CCS because of their racial or ethnic origin.  We will enable and support all efforts to become aware of and eliminate racism and racist behaviors within CCS and the broader community.  We will take exceptional steps to identify and root out such biases, especially where there appear to be long standing, institutional patterns of unacceptable behavior or lack of performance.

JOB CONDITIONS:

Working conditions include working in an office environment, in family homes, in and about the community. Regular working hours may occur any day of the week or time of the day.

Catholic Community Services and Catholic Housing Services is an Equal Opportunity Employer. Please let us know if you need special accommodations to apply or to interview for this position.

Salary : $99,750 - $114,713