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Form of workJob Description
Associate Director of Quality Management will provide leadership and oversight over quality assurance and quality improvement responsibilities, initiatives, and tasks throughout the organization.
Essential Functions:
- Guides the vision and goals for the agency by working with Program Leadership to achieve and maintain regulatory compliance for all clinical charts in the agency, create optimal billing practices, and address ongoing training needs.
· Oversees and maintains compliance for all licensing, credentialing, certification bodies (HIPAA, The Joint Commission, DHCS, SFDPH/CBHS, DSS/CCL, Private Insurance, out of county, etc.) in collaboration with Regional and Program Directors. Compliance requirements include but are not limited to contract compliance, outcome evaluation, clinical documentation, EHR compliance, data integrity, required reporting, and preparing for contract audits, credentialing and organization site visits. Performs ongoing compliance monitoring activities.
· Creates agency-wide systems to ensure consistent review of Quality practices.
· Participates in leadership meetings including Directors, Supervisors/Managers, and the Health & Safety Committee.
· Develops internal and reporting systems, procedures, and workflows to maximize productivity, efficiency and the efficacy of services, to enhance accessibility for underserved populations, and ensure all programs are appropriately suited to meet the needs of the diverse communities we serve.
· Provides compliance feedback on all new EHR features and coordinates set-up of new programs in EHR
· In partnership with the Head of Compliance, Privacy, and Information Security, creates and implements CQI (Continuous Quality Improvement) projects on an annual basis.
· Ensures HIPAA compliance as related to programs with respect to charts/clinical practices and policy implementation
· Supports the regional workforce development strategy in partnership with the Director of Training and Director of Human Resources.
· Oversees compliance with incident reporting regulations and coordinates the development of a monthly incident report, and other data reports as needed, to be submitted to the board.
· Supervises Quality Management Managers and Quality Management Administrative Coordinators. Provides direction, monitors job performance and evaluates progress towards employee goals.
· Oversees record management from creation of record to the record destruction. Ensures record management policies and procedures comply with laws and regulations, contracts, and accreditation standards.
· Provides guidance, training, and consultation to direct service providers and managers related to mental health service provision, documentation standards, and billing requirements. Performs internal chart reviews and audits to ensure the client record meets all regulatory, accreditation, and best practices standards.
· Collaborates with programs, IT, and Finance departments to reconcile services provided and billed. Oversees regional procedure for on-going monitoring of client eligibility, client authorizations, billable/non-billable services and billing errors across programs. Works with internal departments and external county systems to trouble shoot and correct billing errors.
· Works collaboratively with agency departments to ensure internal/external requirements are met and that agency systems (e.g. Electronic Health Record, Learning Management System, and Payroll System, etc.) are used to meet staff and program needs, increase efficiency, collect/report data, and enhance communication.
· Maintains relationships with external partners and participates in provider meetings. Responds to county requests in a timely manner and ensures submission of required documents and reports when requested.
Qualifications:
* Previous experience in behavioral health Quality Management, regulatory compliance, or utilization review
* Solid understanding of Medi-Cal and TJC requirements as they relate to the charting and billing of Mental Health Services.
