Program Integrity & Investigations Specialist

CRi is seeking a Program Integrity & Investigations Specialist to join our team! 

Position Summary:

The Program Integrity and Investigations Specialist at CRi is responsible for monitoring program compliance in alignment with federal and state behavioral health provider regulations and industry standards. This role involves conducting thorough investigations into violations of Human Rights to ensure the protection and dignity of individuals served. Additionally, the Specialist performs comprehensive audits across all service programs, identifying areas for improvement and strengthening organizational oversight. 

By driving adherence to regulatory requirements and best practices, this position plays a critical role in enhancing service quality, promoting accountability, and supporting continuous improvement within the organization.

Principal Duties and Responsibilities:

Program Compliance Monitoring: Reviews program files (medical, financial, service planning) and conducts environmental inspections to ensure compliance with regulations and the Clinical Policy and Procedure Manual.

Audit and Review: Conducts audits, identifies areas for improvement, and supports corrective action plan development and implementation.

Investigations: Leads internal investigations into compliance issues (e.g., abuse, neglect) and prepares accurate reports.

Quality Improvement and Compliance (QIC) Oversight: Supports internal QIC reviews, prepares quarterly reports, and helps monitor and improve service delivery processes.

Recommendations and Systemic Improvements: Prepares recommendations for program and systemic improvements and evaluates the impact of changes on compliance and performance.

Regulatory Inspections and Reporting: Participates in inspections, contributes to compliance reports, and prepares monthly, quarterly, and annual QIC activity reports.

ICF Manual Maintenance: Maintains and updates the agency’s ICF manual to ensure it reflects current regulatory standards.

Operational Support: Assists with audits and creates tools, templates, and guidance documents to improve operational efficiency.

Additional Duties: Performs other duties as needed to support departmental and organizational goals.

Other Job Functions:

• Maintain appropriate level of confidentiality, while practicing the level of transparency valued by the agency.
• Assist in setting standards for a professional corporate image through quality and friendly service, communication and presentation, by working well with staff at all levels, as well as consumers and external contacts, including individuals of diverse cultures and capabilities.

Minimum Qualifications Required:

• Bachelor’s degree in healthcare administration, business administration, social science, or related field Will consider a combination of education and 5 years of experience in intellectual disabilities program supervision or auditing.
• Ability to interpret complex regulations, maintain confidentiality, conduct research, make recommendations, and implement solutions. Strong analytical, verbal, written, and presentation skills.
• Ability to work independently, make sound judgments, and handle competing priorities.
• Demonstrated knowledge of, or strong interest in, working with individuals with disabilities, preferred.
• Proficiency in MS Office (Word, Excel, PowerPoint), and experience Electronic Health Record (EHR) usage.
• Familiarity with CMS, Virginia DBHDS, DSS, and/or CARF; experience with these agencies is strongly preferred.
• Proven strong organizational skills.

Desired Qualifications:

• Experience working in the developmental disability and/or mental health field.

Physical Demands:

• Reliable transportation for travel to program sites in Virginia (Northern VA and Richmond)
• Standing, sitting, and lifting up to 5-10 lbs.

Working Environment:

• Programs and other locations throughout CRi’s service areas, including Richmond.
• Office environment.

Supervision Received

Under direct supervision of the Quality Improvement and Compliance Director.