Quality Assurance Coordinator

Organization: Sick Kids [need] Involved People of New York (SKIP)

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Location: Rochester, New York

Job Title: Quality Assurance Coordinator

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Qualifications
The Quality Assurance Coordinator position is a multipurpose position requiring at least a Bachelor’s Degree in health/human services, education, communications, quality or related field. Minimum of 1 year experience working in human/social service systems supporting children and families with long term, chronic health conditions or developmental disabilities required. Prior Health Home Care Management experience desirable, along with experience in continuous audits, quality improvement initiatives and use of electronic health record systems.

Excellent organization, time management and communication skills are essential to the position.
Quality Assurance Coordinator reports to Director and/or VP of Health Homes, participates in a team-based management model and responds to applicable work issued by their supervisor.

Hours
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Full-Time 37.5 Hours/Week, In-Office

QA Coordinator functions as an important and versatile member of the Health Home Care Management team, responsible for ongoing audits and quality assurance initiatives, with additional responsibilities in support of care management staff and administrative tasks as assigned by Supervisor/Director/VP. The function of Quality Assurance is to ensure the best possible work product for the individuals we support, their families, and the organizations with which we interact.

The responsibilities and essential job functions of this position are ever evolving with changing regulatory requirements and program priorities.

• Conduct comprehensive reviews of client records, both physical and electronic.
• Obtain essential documentation from different governing bodies and collateral contacts.
• Complete audits across caseloads including introductory, full audits, billing, audits of records in process of closure or transition from Health Homes, and external state/OMIG audits.
• Prepare case files to be purged, checked and/or scanned.
• Utilize internal tracking systems to ensure compliance of required eligibility and level of care.
• Support the team to address needs of families served in a consistent and timely manner.
• Update shared lists of resources and agency/provider contact information to be used by staff.
• Develop and implement various trainings as needed, including those on QA and program policies.
• Review and process Child and Adolescent Needs and Strengths (CANS) assessments. Complete Plan of Care, Consent and various programmatic documentation reviews/updates as needed.
• Obtain relevant disability documentation. Process HCBS LOC Eligibility determinations in UAS.
• Support care management staff to maintain neat and presentable physical & electronic case records for each person served, maintaining quality/audit-ready records. Scan and save files to EHR.
• Complete reports and other administrative tasks for Supervisors, Directors and others. Effectively utilize Health Home quality reporting metrics to help guide workflow.
• Submit DSS-5144 disability determination packets to the state and track accordingly, along with following up to obtain SSA, chronic condition and supporting documents to maintain client eligibility.
• Assist Director/VP to document program processes, ensuring all regulations and changes are communicated and shared with staff. Help create and train to policies & procedures as needed.
• Assist the department with additional responsibilities in support of care management staff and administrative tasks as assigned by Supervisor/Director.
• Conduct family satisfaction surveys, relaying feedback and follow-up to appropriate personnel.
• Oversee Gaps in Care and Clinical/Transitions of Care follow-up, sharing relevant guidance with staff.
• Assist with HCBS Referral/Authorization follow-up and Incident Reporting-Tracking. Use of IRAMS.
• Support Care Managers with family/provider follow-up. Model appropriate communication. Attend meetings with clients and families in the community, helping with intakes or other cases in need of temporary coverage as needed. Write case notes for all case related contacts/tasks completed.
• Audits of client records may entail the following tasks:
  Review cases in a continual cycle unless instructed to review specific cases;
  Effectively utilize and maintain SKIP, DOH and Health Home QA/Audit Tools;
  Respond to Health Home comprehensive, process audits, quarterly and routine quality checks, taking applicable proactive steps to ensure SKIP continues to pass all Health Home audits;
  Assist with prescribed performance improvement follow-up and issues remediation, and participate in communications with Health Home partners as needed;
  Conduct technical review consisting of chart conformity to SKIP/Health Home filing protocol; documentation timeliness; content, active support to move forward client plans of care; review of technical eligibility…