Quality Service Review Specialist (Bhjob1435_31788)

Quality Service Review Specialist

**Must have reliable transportation and the ability to travel to individual residences, provider offices, and service sites throughout Northern Virginia. **
JOB SUMMARY:
Conducts individual service plan (ISP) and case file reviews; conducts interviews of individuals with intellectual and/or developmental disabilities, their family members, support coordinators, direct care workers, providers, and others; and observes individuals receiving care and services included in their ISP.

ESSENTIAL RESPONSIBILITIES:

• Complete QSR training and maintain a 95 percent interrater reliability confidence level in the implementation of the QSR processes and documentation of responses and results in the electronic tools.
• Conduct onsite individual service plan reviews to assess whether the ISPs meet the requirements and intent of the Centers for Medicare and Medicaid Services (CMS) Home and Community-Based Services (HCBS) Settings Final Rule and the Virginia Department of Justice (DOJ) Settlement Agreement (SA).
• Conduct chart and/or record review in service delivery sites, including the places where the individuals reside for compliance with the HCBS Settings Rule and the Virginia DOJ SA.
• Conduct face-to-face interviews regarding the implementation of the individual service plan to assess whether implementation of the care plan meets the requirements and intent of the HCBS Settings Rule and the Virginia DOJ SA. Conduct the interviews with the following:
  • Individuals with intellectual and/or developmental disabilities
  • Family member or guardian
  • Support Coordinator
  • Service provider
  • Service provider supervisory staff
  • Direct care worker
  • Others that may be identified
• Conduct observation of the individual receiving services specified in their individual service plan.
• Review and consider results of provider licensure surveys, complaint investigations, and compliance reviews conducted by the Medicaid agency, Human Rights Committee, and others as required in the development of the QSR (Person-Centered Review [PCR] and Provider Quality Review [PQR]) result reports.
  • Use professional judgment to assess observed risks to the health or safety of the individual.
  • Complete documentation of reviews, interviews, and observation activities as specified.

QUALIFICATIONS:

• Bachelor’s, Master’s, or Doctoral degree in a human service-related field.
• A minimum of three years experience in a human service-related field such as long-term services and support.
• At least three years of ID/DD experience.
• Familiar with and know how to navigate the Virginia Waiver Management System (WaMS)
• Experienced in conducting chart reviews, audits, interviews, focus groups, and observation activities.
• Experience in or understanding of requirements of the Medicaid program, public health, state licensure or other accrediting agency; state developmental disability; and; DD Waiver services administrative code.
• Knowledge and experience in the application of healthcare confidentiality requirements (e.g., HIPAA).
• The ability to communicate professionally and effectively, orally and in writing, with professional staff and individuals with intellectual and/or developmental disabilities and their family members/guardians.
• Preferred qualification as a social worker, support coordinator, behavioral health professional or technician, LPN or RN
• Preference will be given to certified professionals in healthcare quality, healthcare compliance, or compliance audit experience.
• Positions are full time and candidates must be available from 8:00 a.m. to 8:00 p.m. for scheduled onsite reviews, interviews, and observation.
• Candidates must also be able to sit for prolonged periods.

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