Program Monitoring Specialist II
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 2 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!
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.
We are seeking a Program Monitoring Specialist II 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.
- 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.
- Leads and coordinates all external quality audits occurring for assigned programs, this includes coordinating all external audits between the auditors and programs.
- In conjunction with the Director of Program Monitoring, develops the PIP/CAP that are a result of an external audit.
- Initiates audit reports and distribute to Director and VP of the programs. Provides support to the audited site with development of corrective and preventative actions to address any significant non-compliance identified in the audits as needed.
- Working under the direction of the VP of Corporate Compliance and Risk Management and 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.
- Work collaboratively with the QM department staff to conduct trainings to all staff as needed.
- Assists with external QM review and audit processes.
- Develops and implements clinical quality improvement plans.
- 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 VP of Corporate Compliance and Risk Management, SBH leadership, and other committees as needed. Works with internal departments to correct QM issues
- Collects and tracks quarterly program internal audit data.
- Communicates with RBHA, Health Plans and funding sources regularly to clarify documentation requirements, content, and outcomes.
- 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.
- 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 related field required, Master’s Degree preferred.
- 4 years of directly related experience required; Documentation of education and relevant experience required.
- Prior working experience that lends to clinical quality management and experience in clinical records documentation requirements.
- Working Knowledge of SAMHSA regulations and grant funding, AHCCCS billing,ADHS licensure, and T/RBHA clinical documentation and program requirements.