Clinical Quality Assurance Analyst
Clinical Quality Assurance Analyst
Southwest Behavioral & Health Services is a large and growing, non-profit community-based provider of behavioral health services with locations throughout the Phoenix metropolitan area, rural Maricopa County, Gila, Pinal, Mohave, Coconino, and Yavapai Counties. We are a well-established voice in the community with more than 115 sites, over one thousand employees, and 40 years’ experience.
Join Southwest Behavioral & Health for exceptional growth opportunities driven by our promote-from-within philosophy. We provide an EXCELLENT compensation and benefits package, including immediate participation in our 403(b) program with 20% company match after 1 year of service. Generous Paid Time Off (PTO) includes 3 weeks of time-off your 1st year (available after 6 months) and increased vacation accruals after 2, 5 and 10 years of service! We offer low cost medical insurance and offer 100% company-paid dental, Short Term Disability, Long Term Disability, and Life coverage for employees. Other great benefits include 10 paid holidays, vision, licensure/certification reimbursement, tuition reimbursement, prescription drug discounts, chiropractic services, 100% paid Employee Assistance Program, and much more!
We are seeking a Clinical Quality Assurance Analyst II to join our team!
Under the general supervision of the Director of Quality and Utilization, this position is primarily responsible for the internal auditing, training, and clinical quality assurance management as relates to the quality of clinical records and regulatory/fund source documentation requirements. Analyzes, tracks, reports, and follows up on quality management and compliance issues. Performs clinical support for staff through training and attention to clinical documentation issues. Works with Compliance, VP’s and Directors to insure positive outcomes with the highest performance standards.
Duties & Responsibilities:
- Manage and schedule quarterly internal quality audits for all assigned programs company-wide for quality and compliance with AHCCCS, ADHS, T/RBHA, Health Plans and other funding source documentation requirements.
- Leads and coordinates all external quality audits occurring for assigned programs, this includes coordinating all external audits between the auditors and programs.
- Tracks and develops specific trends for programs in areas of strengths and needs for quality audits.
- Presents and trains staff on trends identified from both internal and external audits.
- Initiate audit reports and distribute to Director and VP of the programs. Provide support to the audited site with development of corrective and preventative actions to address any significant non-compliance identified in the audits as needed.
- Performs collections, compilation, analysis and reporting of assigned quality metrics.
- Working under the direction of the Chief Compliance Officer and the Director of Quality and Utilization Management, assist in the investigation of internal or external quality related events. Verify corrective and preventative actions are in place and working as part of the internal audit process.
- Work collaboratively with the QM/UM department staff and Compliance department to conduct trainings to all staff as needed.
- Assists with external QM/UM review and audit processes.
- Develops and implements clinical quality improvement plans.
- Work collaboratively with the Director of QM/UM to develop and/or review QM/UM policies/procedures and roll out to staff.
- Analyzes, tracks, and reports general trends in documentation as relevant to compliance issues and keeps ongoing records of outcome data
- Prepares summary reports, recommendations, and presentations to Corporate Compliance Officer, SBH leadership, and other committees as needed. Works with internal departments to correct QM/UM issues
- Uses tact and sensitivity and communicates effectively with all internal and external customers including but not limited to: SBH personnel, funding sources, regulatory agencies, etc.
- Communicate the on-going changes to Clinical Staff regarding the program, chart documentation, utilization review, referrals, admissions and discharges.
- Advises the staff of the quality and efficacy of the clinical records and whether records substantiate the level of care that is being provided and ways to improve the quality of the clinical record as a means of better substantiating services being provided at each level of care.
Education & Qualifications:
- Master’s Degree and license preferred.
- Bachelor’s Degree in Behavioral Health or directly related field, plus 4 years of directly related experience required; or equivalent combination of education and direct experience (1 year college = 1 year experience). Documentation of education and relevant experience required.
- Prior working experience that lends to clinical quality management and sufficient experience in clinical records documentation requirements.
- Working Knowledge of AHCCCS billing, ADHS licensure, and T/RBHA clinical documentation and program requirements.