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Quality Management Specialist

Company: North Texas State Hospital - Wichita Falls Campus
Location: Wichita Falls
Posted on: June 12, 2021

Job Description:

Program Specialist V

The HHSC Behavioral Health Services Quality Management (QM) Specialist works under the supervision of the Quality Management Manager, or his/her designee, performing complex, advanced consultative and technical work requiring specialized knowledge in the evaluation and continuous improvement of services, programs and organizations. Works as a team member. Plans, develops, implements and functions as team member/leader for onsite & desk reviews and studies to determine service quality and compliance with contracts, grants, laws, regulations, policies, and procedures to continuously improve the quality and efficacy of services. Evaluates the services delivered to consumers and business functions for managing care, ensures the effective communication of findings to customers, evaluates providers? plans of correction/improvement and conducts follow-up to determine if improvements have been made and maintained. Conducts highly advanced assessment of multifaceted compliance information from within the division, across the agency and from auditing information to determine monitoring needs and steps to bring a contractor into compliance. Leads, participates and contributes in cross-functional teams/workgroups, trainings and inter-agency and intra-agency work. Performs Lead role in Behavioral Health Services (BHS) and unit initiative implementation. Designs, develops and implements effective policies and protocols for evaluation and monitoring of business functions and service delivery; to include designing, collecting, synthesizing, analyzing and evaluating performance measures and other data. Work includes developing performance reports, conducting data analysis to evaluate the effectiveness of systems, standards, and policies. Collects, analyzes and performs complex interpretation of data to evaluate performance, utilization, compliance with laws, regulations, policies, procedures, contractual performance indicators, best practices, organizational risks and service delivery gaps and make recommendations to management and providers. Studies and analyzes operations and prepares reports of findings and recommendations, prepares administrative reports, studies, and specialized research projects. Participates in activities such as risk assessment to determine priorities for the evaluation and the development of standards and procedures for major departmental initiatives. Performs complex analysis and interpretation of data to identify trends and best practices, makes recommendations to management and providers. Produces professional, accurate communications, provides technical support and training related to compliance, quality management and identification of best practices, makes presentations and responds to inquiries from providers and the community. Works under limited supervision with considerable latitude for the use of initiative and independent judgment and sometimes supervises the work of others.

Essential Job Functions:
Essential Job Functions:
EJF1. Plans, implements and functions as Review leader for onsite, desk, focused and statewide reviews to assess service quality and compliance with Behavioral Health contracts, grants, applicable Federal and state laws, regulations, policies, and procedures; and prepares the required reports or responses as appropriate. Maintains positive work relationships with internal and external stakeholders. Evaluates organizational systems, business functions and the quality and efficacy of services. Evaluates plans of correction/improvement and conducts follow-up to determine if improvements have been made and are maintained, and works with contract manager/project officer to recommend sanctions and penalties. (40%)
EJF 2. Develops and implements policy and protocols for evaluation of business functions, service delivery and outcomes; employs quality management methods to collect, synthesize, analyze and use data in the process of facilitating continuous improvement within organizations providing Behavioral Health services. Conducts studies and specialized research projects, represents Quality Management Unit on workgroups to develop standards and processes for new agency initiatives within a team model. (15%)
EJF 3. Participates in activities such as risk assessment to determine priorities for the deployment of oversight resources; performs analysis and interpretation of data to identify trends and best practices. Uses data and knowledge of the system to make recommendations to management and providers to improve the quality or efficiency of processes. Participates in performance measurement and identification of providers at risk of non-compliance with the contract or delivering poor quality Behavioral Health services. (15%)
EJF 4. Ensures communication of findings to Behavioral Health providers during review exits and technical assistance. Produces professional communications including but not limited to letters, technical reports, executive summaries, charts, graphs, minutes, memos, e-mails, slide show presentations. Responds appropriately to queries from the field, the public and within the agency and complaints regarding Behavioral Health programmatic compliance. (10%)
EJF 5. Provides consultation and technical assistance related to quality management, increasing compliance and effective oversight of contracts to managers, staff, LMHAs, providers and stakeholders maintaining positive work relationships with internal and external stakeholders. Provides training for QM staff and others within the agency, providers and members of the community in compliance, quality improvement, identification of best practices and the development of new methods and procedures. (10%)
EJF 6. Identifies methods to improve processes and the efficiency of unit activities. Participates in evaluations of interrater-reliability to ensure accurate and consistent findings. Plans, assigns, guides and oversees the work of BHS
QM staff when functioning as a project manager or team leader and is responsible for the efficient and effective deployment of resources within the team model. (5%)
EJF 7. Performs other duties as assigned. (5%)

Knowledge Skills Abilities:
Knowledge Skills Abilities:
Knowledge of the application of the principles of quality management for improvement of Behavioral Health services
Knowledge of state, and federal laws, agency regulations, policies, rules and requirements pertaining to the provision of BHS services in the community
Knowledge of laws and rules applicable to confidentiality and the management of protected health information
Knowledge of data systems for managing operations and making decisions
Skill in effective verbal communication and public speaking, and interpretation and presentation of complex data sets and analysis
Skill in project management with complex projects that cross agencies and several lines of business
Skill in identifying problems, evaluating alternatives, and negotiating and implementing solutions to organizational and service delivery problems
Skill in advanced business and technical writing, data analysis, reporting, and interpretation of complex data sets related to provider performance
Ability to organize and present information effectively, both orally and in writing
Ability to analyze and solve work problems affecting the operations and functions
Ability to provide information to providers regarding areas of non-compliance and less than acceptable quality in an informative non-threatening manner
Ability to plan, organize and manage large multi-faceted projects and work in collaboration with others to manage multiple deadlines
Ability to plan, assign and manage the work of others

Registration or Licensure Requirements:

Initial Selection Criteria:
Initial Screening Criteria: Initial Screening Criteria: Bachelor's Degree with major course work in human service from a U.S. accredited college, university, or foreign degree determined to be equivalent by an acceptable education evaluator. Relevant experience may be substituted for education on a year to year basis.
Experience in:
? applying the quality improvement principles and evaluating quality and compliance of services and/or processes and evaluating contractual programmatic service delivery
? evaluating compliance with state and federal laws, agency regulations, policies, rules and requirements for the provision of Behavioral Health services in the community
? evaluating compliance with laws and rules applicable to confidentiality and the management of protected client information
? developing professional relationships and representing an agency within local communities and to state government
? planning and teaming with work teams, work groups or other team models to complete job duties

Additional Information:
Additional Information: Knowledge of Medicaid managed care programs, policies, procedures, contracts, and service delivery mechanisms desired but not required

MOS Code:

HHS agencies use E-Verify. You must bring your I-9 documentation with you on your first day of work.

- Click here to download the I-9 form.

In compliance with the Americans with Disabilities Act (ADA), HHS agencies will provide reasonable accommodation during the hiring and selection process for qualified individuals with a disability. If you need assistance completing the on-line application, contact the HHS Employee Service Center at 1-888-894-4747. If you are contacted for an interview and need accommodation to participate in the interview process, please notify the person scheduling the interview.

Keywords: North Texas State Hospital - Wichita Falls Campus, Wichita Falls , Quality Management Specialist, Other , Wichita Falls, Texas

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