Quality Improvement Specialist- CCBHC Macari
The Child Center of NY, New York, NY, United States
The Child Center of NY strengthens children and families with skills, opportunities, and emotional support to build healthy, successful lives. Founded in 1953, The Child Center of NY has become a powerful community presence throughout the city. With 50 locations and 100 programs in NYC’s most under‑served communities, our 1,000+ results‑oriented professionals make a difference for more than 40,000 children and their families each year.
Summary
The Quality Assurance/Improvement Specialist is responsible for developing, monitoring, and implementing strategic quality improvement processes in the Behavioral Health Division. The Quality Improvement Specialist works with program directors and staff to assure the performance and quality of care and services for the persons and families served by The Child Center of NY.
Essential Functions
Maintain up-to-date knowledge of the program, licensing body, government and accreditation regulations to ensure compliance, communicating and addressing any changes as they may occur. This includes researching and advising on regulatory compliance questions, as needed.
Independently develop processes and procedures to ensure quality client services and compliance with professional standards.
Conduct, document and track QA functions including utilization/chart reviews to ensure compliance with all regulations, identify patterns/trends of challenges, and follow through on corrective actions.
Billing reviews ensuring all Medicaid billing is supported by accurate documentation.
Submission of routine summaries with all findings, QI plans and associated data.
Maintain and ensure compliance with client and agency confidentiality standards and ethical expectations.
Collaborate on a routine basis with program leadership to develop and review standardized tracking and reporting for incident and chart reviews, compliance and best practice gaps, analyzing findings to develop quality improvement plans, monitor implementation of such plans, and provide training/coaching when necessary.
Ensure communication with program staff about performance and quality of care/services within the level of complexity that program staff are able to understand, using discretion as per his/her expertise in understanding and interpreting quality and performance data and with support from leaders with additional expertise when necessary.
Advise senior management on issues such as program performance and quality matters by making educated and intellectual interpretations and summaries of quality and performance data.
Develop in‑house expertise in the various electronic management systems used by assigned programs for data review, reporting, and billing purposes. Address/train program staff in these systems.
Perform other related duties as assigned.
Minimum Qualifications
Masters Degree and LQHP- LMSW, LMHC, LMFT with clinical experience.
Prior experience with Medicaid funded program.
Prior knowledge of Medicaid and HIPAA regulations.
Ability to work independently on multiple tasks while meeting deadlines.
Comfort level with large data sets, statistics and billing information.
Excellent communication skills, both written and verbal with good public speaking and presentation skills.
High level of skill with MS Office software including Word, Excel, Outlook and knowledge of management information systems. Willingness and ability to learn new systems.
Schedule
Hybrid
Physical Demands
While performing the duties of this job, the employee is occasionally required to walk, sit for long period of time; use hands to finger, handle, or feel objects, tools, or control; reach with hands and arms; balance; stoop; talk or hear. Employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.
The Child Center of NY is an Equal Opportunity Employer. All applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status or any other category protected by Federal, State or local law. EOE M/F/D/V
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Summary
The Quality Assurance/Improvement Specialist is responsible for developing, monitoring, and implementing strategic quality improvement processes in the Behavioral Health Division. The Quality Improvement Specialist works with program directors and staff to assure the performance and quality of care and services for the persons and families served by The Child Center of NY.
Essential Functions
Maintain up-to-date knowledge of the program, licensing body, government and accreditation regulations to ensure compliance, communicating and addressing any changes as they may occur. This includes researching and advising on regulatory compliance questions, as needed.
Independently develop processes and procedures to ensure quality client services and compliance with professional standards.
Conduct, document and track QA functions including utilization/chart reviews to ensure compliance with all regulations, identify patterns/trends of challenges, and follow through on corrective actions.
Billing reviews ensuring all Medicaid billing is supported by accurate documentation.
Submission of routine summaries with all findings, QI plans and associated data.
Maintain and ensure compliance with client and agency confidentiality standards and ethical expectations.
Collaborate on a routine basis with program leadership to develop and review standardized tracking and reporting for incident and chart reviews, compliance and best practice gaps, analyzing findings to develop quality improvement plans, monitor implementation of such plans, and provide training/coaching when necessary.
Ensure communication with program staff about performance and quality of care/services within the level of complexity that program staff are able to understand, using discretion as per his/her expertise in understanding and interpreting quality and performance data and with support from leaders with additional expertise when necessary.
Advise senior management on issues such as program performance and quality matters by making educated and intellectual interpretations and summaries of quality and performance data.
Develop in‑house expertise in the various electronic management systems used by assigned programs for data review, reporting, and billing purposes. Address/train program staff in these systems.
Perform other related duties as assigned.
Minimum Qualifications
Masters Degree and LQHP- LMSW, LMHC, LMFT with clinical experience.
Prior experience with Medicaid funded program.
Prior knowledge of Medicaid and HIPAA regulations.
Ability to work independently on multiple tasks while meeting deadlines.
Comfort level with large data sets, statistics and billing information.
Excellent communication skills, both written and verbal with good public speaking and presentation skills.
High level of skill with MS Office software including Word, Excel, Outlook and knowledge of management information systems. Willingness and ability to learn new systems.
Schedule
Hybrid
Physical Demands
While performing the duties of this job, the employee is occasionally required to walk, sit for long period of time; use hands to finger, handle, or feel objects, tools, or control; reach with hands and arms; balance; stoop; talk or hear. Employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.
The Child Center of NY is an Equal Opportunity Employer. All applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status or any other category protected by Federal, State or local law. EOE M/F/D/V
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