Program Monitoring Specialist I - Quality Management
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 seven hundred 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 40% company match after 1 year of service. Generous PTO includes 3.5 weeks of vacation your 1st year (available after 6 months) and accruals after 2, 5 and 10 years of service! We offer 100% company-paid medical, dental, STD, LTD, and Life coverage for employees. Other great benefits include 10 paid holidays, sick time, vision, tuition reimbursement prescription drug discounts, chiropractic services, and much more!
We are seeking a Program Monitoring Specialist I to join our team! The position will work Monday through Friday 8 AM to 5 PM. May work days, evenings, and/or weekends to meet the needs and demands of position.
Under the general supervision of the Director of Program Monitoring, this position is primarily responsible for theinternal auditing, training, and quality assurancemanagement 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 support for staff through training and attention to clinical documentation issues. Works with Quality Management, VP’s and Directors to insure positive outcomes with the highest performance standards.
- Manage and schedule 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.
- Initiate audit reports and distribute to Program Coordinator, 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 Director of Program Monitoring, 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.
- Assists with external QM review and audit processes.
- Develops and implements quality improvement plans.
- Prepares summary reports, recommendations, and presentations to Director of Program Monitoring, VP of Quality Management, SBH leadership, and other committees as needed. Works with internal departments to correct QM issues.
- Communicates with RBHA, Health Plans and funding sources regularly to clarify documentation requirements, content, and outcomes.
- Work collaboratively with the Director of Program Monitoring to develop and/or review QM policies/procedures and roll out to staff.
- Communicates changes in clinical record requirements to staff and supervisors.
- 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.
- Provides in-services to the staff as needed on documentation as it relates to internal and external regulatory and funding source rules and regulations.
- Maintains the integrity and confidentiality of all client information.
- Conducts special evaluation studies as assigned.
- Will serve on company committees when requested by supervisor.
- To ensure compliance & adequate services, additional job duties may be required to meet the needs of the program and or department, this includes cross-training with the department.
Education & Qualifications:
- Bachelor’s Degree in Behavioral Health or directly related field, plus 2 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.