Part-Time Temporary Quality Assurance Reviewer

Remote position in the Miami-Dade County area. 

The Quality Assurance Reviewer determines the degree to which individuals with intellectual or developmental disabilities (I/DD) are receiving person-centered supports and services according to their needs and goals. Determines the degree to which developmental disability service providers ensure individuals health and safety for individuals receiving services and conform to program standards while meeting state requirements. This position requires travel within Dade County and you must speak Spanish/English fluently. 

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and Quality Assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country.

In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

Best People, Best Solutions, Best Results

The Quality Assurance Reviewer determines the degree to which individuals with intellectual or developmental disabilities (I/DD) are receiving person-centered supports and services according to their needs and goals. Determines the degree to which developmental disability service providers ensure individuals health and safety for individuals receiving services and conform to program standards while meeting state requirements. 

Essential Duties and Responsibilities:

• Conducts detailed evaluations of provider performance and the presence of person-centered supports using applicable tools and guidelines.
• Initiates contact with service providers to establish interview and review schedules and discuss associated protocols, expectations, and responsibilities.
• Conducts interviews with individuals with I/DD, family members, providers of services and/or direct service staff.
• Observes the service environment, follows professional protocols to gather pertinent information and makes decisions for the evaluation process.
• Reviews required documentation to evaluate supports and services and gather pertinent information regarding the quality of the person-centered service delivery system.
• Administers and makes determinations based upon the information gathered from the Person Centered Review (PCR), Provider Discovery Review (PDR) and other applicable tools in a manner that meets established proficiency standards.
• Serves as an expert in identifying both problems and solutions to ensure Quality Assurance activities appropriately address the needs of individuals with I/DDs. Recognizes each personal situation may be different and uses analytical skills to customize the approach as needed.
• Establishes and maintains a positive and respectful approach with individuals/family members/providers/support coordinators throughout the review process.
• Uses professional judgment and discretion to determine when a report of abuse, neglect and/or exploitation is warranted or a referral to state staff is necessary to maintain the health and safety of individuals receiving services through the Medicaid Waiver program.
• Takes immediate action in the case of abuse, neglect and/or exploitation by reporting directly to the Abuse Registry following established protocols of a mandated reporter.
• Inputs data into a web-based application, summarizes findings, generates discoveries for quality improvement and completes a written report for submission to the provider/support coordinator/or other entity in accordance with pre-established timeframes.
• Works closely with the State Agencies to provide information to facilitate follow-up and technical assistance.
• Provides the State Agencies with information at quarterly meetings concerning provider performance, data trends, and opportunities for quality improvement initiatives.
• Participates actively and effectively in associate development activities such as conference calls, professional meetings, and annual training activities.