Quality Assurance Manager
Full Time
Spokane, WA 99260
$73,214 - $102,437 a year
Posted Today
Job description
Job Summary
This position works 37.5 hours per week.
The position allocated to this classification is responsible for the effective collaboration and coordination of strategies, execution of initiatives, assigned projects and processes to transition to a successful Integrated Care Services system (ICS) for public mental health and substance abuse treatment. This position maintains and continuously improves the quality of operations; clinical services delivery, adherence to compliance regulations; on-going and up-to-date monitoring and training of behavioral health providers within the designated region of care; and provides behavioral healthcare services, healthcare coordination or authorization and utilization reviews of behavioral health services for eligible individuals. As directed by the Integrated Behavioral Healthcare Manager, the incumbent supervises Integrated Care Coordinators, Integrated Behavioral Healthcare Project Coordinators, and Planners/Evaluators, Housing and Community Support Specialists, Peer Support Specialists, and the coordination of clinical quality and compliance to meet the goals of the Department. Work is performed with considerable independence, under the direction of the Integrated Behavioral Healthcare Manager and other department leadership, and in alignment with the overall mission and vision of CSRBH. Results are reviewed by achievement of goals and effectiveness in meeting objectives. This is an at-will position.
TOTAL COMPENSATION: $93,713 - $131,118 annually. Total compensation is an estimate based upon base compensation, median retirement fund contributions, and current employer-paid health and related benefit contribution rates (including medical, dental, life insurance, long term disability, and leave). The actual total will vary depending upon each employee's enrollment choices.
Examples of Duties
- SCRBH (ASO) Integrated Behavioral Healthcare Quality Supervisor:
- Selects, supervises, trains, mentors, motivates and evaluates the performance of assigned staff.
- Assists in the development and implementation of training and professional development plan to include timely performance reviews.
- Participates in interviewing and orientations of new staff.
- Makes recommendations to CSD leadership regarding hiring selections and disciplining staff.
- Provides leadership, oversight and direction to other employees within the team and the agency through the CSRBH (ASO) Plan implementation.
- Manages and maintains CSRBH (ASO) Division’s agency-wide work plans, coordinating efforts to ensure quality services and completion of agency goals and objectives. Work plan coordination includes overseeing performance measurements, facilitating task timeliness, coordinating projects/teams, project site administration and supports the Leadership Team Advisors to the CSRBH Plan.
- Oversees and manages authorization review process providing direct assistance to staff, completing authorization review requests within required time-frames, ensuring reviews are being completed within medical necessity criteria, financial eligibility, and residency, troubleshooting issues or problems, and maintains responsive decision making and notification.
- Engages and works with employees to provide consistent, quality work in a timely manner.
- Provides regular update reports to management and identifies any potential issues and barriers to the integration process.
- Coordinates and manages projects on an ongoing basis; researches and resolves onsite problems.
- Provides support and assistance to various team members related to operational aspects of the integration and business planning process.
- Assists in the development, maintenance, and update of the continuing quality improvement process for the CSRBH Division.
- Evaluates performance reports and other data to determine trends, productivity and quality measures to identify areas of strength and areas for improvement.
- Provides technical assistance to providers to improve performance as needed.
- Oversees administrative management of the Grievance System, to include grievances, appeals and fair hearings. Identifies trends in grievance system and provides training and/or technical assistance to improve satisfaction of individuals in services.
- Develops support mechanisms for and ensures productivity and continued quality improvement of program and staff.
- Maintains collaborative and collegial working relations with all provider employees, allied system staff, inpatient staff, diversion resource staff, individuals, and their families.
- Builds and maintains strong system working relations within the behavioral health delivery system and with allied service systems.
- Assists in providing technical assistance to behavioral health providers within our region of care.
- Organizes, coordinates and participates as the Lead in monitoring with contracted providers to ensure clinical quality, Encounter Data Validation (EDV), including documentation, utilization review, internal and external clinical record reviews and outcomes.
- Ensures the CSRBH operations and practices are compliant with corresponding laws and contract deliverables from the local, state, national levels.
- Provides direction and guidance to individuals, contracted providers, and allied systems to assure alignment with the CSRBH mission and desired outcomes.
- Keeps abreast of hospital daily census and of the reasons for admissions and discharges or lack of movement toward discharge.
- Collaborates with CSRBH (ASO) regarding continued inpatient stay requests by reviewing clinical documentation for required Medical Necessity Criteria; through telephonic consultation and record review; offers clinical opinions regarding level of care, duration, and intensity of care when deemed needed.
- Makes public presentations before professional organizations, media, or public groups to provide information on mental health and substance use disorder matters.
- Promotes interrelationship of services among local public, private and voluntary agencies and organizations.
- Promotes evidence based practices (EBPs) among the provider agencies and develops evaluative tools to determine if the EBPs are successful for individuals in services.
- Encourages the implementation of person centered services and shares information about newly emerging person centered models and programs.
- Develops comprehensive policies and procedures for compliance with state and federal regulations and to facilitate CSRBH operations as requested by CSD leadership.
- Participates in the CSRBH licensure certification reviews, state audits, program monitoring, and/or audits, as required by leadership.
- Understands the role and functions for the CSRBH Integrated Care Coordinators, Integrated Behavioral Healthcare Project Coordinators, Integrated Care Coordinators.
- Ensures contractual, legal and HIPAA compliance.
- Manages and oversees the 5177 Prosecutorial Diversion Program in accordance with the DSHS Office of Forensic Mental Health contract, ensuring program compliance in accordance with statutory and contract guidelines.
- Manages and oversees program statistics, data management, record retention & maintenance.
- Develops and manages the production of program deliverables and statewide reports to ensure contract compliance and meet the needs of WA Research and Data Analysis Division.
- Coordinates and collaborates with 5177 Prosecutorial Diversion Program stake holders and partners in the criminal justice system including the Spokane County Prosecutors Office, the Spokane County Public Defender’s Office, Spokane County Detention Services, Spokane City Prosecutors Office, Spokane City Public Defenders Office, WA State Health Care Authority, and various other partners.
- Initiates, implements, and directs necessary program activities to assure program support, development, and coordination of a continuum of comprehensive services to meet the needs of program participants experiencing severe behavioral health issues.
- Makes public presentations before professional organizations, media, or public groups to provide information on 5177 Prosecutorial Diversion program matters. Establishes and maintains effective working relationships with all levels of stakeholders (including executives and leaders) in achieving effective collaboration and negotiation: health plans, managed care organizations, mental health and substance abuse provider network, medical community, hospitals, private physician practices, Health Care Authority (HCA), designated counties, vendors, affiliated organizations, under the Integrated Behavioral Healthcare Manager's direction.
- Actively supports and incorporates the mission and core values of CSRBH into daily activities.
- Attends and hosts meetings to ensure effective collaboration and negotiation with health plans, managed care organizations, mental health and substance abuse provider network, medical community, hospitals, private physician practices, Health Care Authority (HCA), designated counties, vendors, and affiliated organizations.
- Attends staff meetings, trainings, and seminars as requested.
- Performs other related duties as required/assigned.
- Counseling and Recovery Services (CAReS) Integrated Behavioral Healthcare Quality Supervisor:
- Follows the laws of the State of Washington and the federal government as they pertain to mental health practice.
- Completes all training required by the WAC and RCW’s within the required time frames.
- Attends necessary clinical and supervisory training to improve/enhance/expand clinical and management skills.
- Adheres to state and federal reporting requirements, including Service Encounter Reporting Instructions (SERI).
- Maintains records in accordance with requirements of law, contractual requirements and agency policy.
- Provides direct treatment services in conjunction with supervisor responsibilities, including individual, family, and group therapeutic services.
- Ensure evidence based and best practice standards for managed care as it applies to clinical treatment practice.
- Provides person-centered care services in a culturally sensitive and response manner.
- Provides mental health assessments, develops and implements treatment plans, provides case management referral and care coordination with other mental health professionals, allied treatment providers, and other community partners.
- Provides crisis intervention services when needed and stays familiar with crisis policies and procedures.
- Participates as a team member of this Agency by attending staff meetings and actively participating in agency meetings.
- Attends regular supervision with the Integrated Behavioral Healthcare Manager to maintain quality of care, responds to requests from supervisors in a timely manner, uses time effectively, keeps appointments and is at work and meetings on time.
- Encourages and participates in community networking, supports treatment team meetings developed by other agencies, and attends community meetings as requested and approved by supervisor.
- Provides clinical supervision and direction to Housing and Community Support Specialists, Peer Support Specialists, and Integrated Care Coordinators according to WAC, RCW, and agency policies under the direction of the Integrated Behavioral Healthcare Manager.
- Assigns cases, monitors caseload sizes and productivity, and supports agency performance metrics.
- Addresses client concerns and complaints, makes decisions regarding client care and resource allocation in conjunction with the Integrated Behavioral Healthcare Manager.
- Provides clinical and administrative oversight in the absence of the Integrated Behavioral Healthcare Manager under the direction of the CSRBH Director.
- Provides and implements medical necessity training upon hire and as needed to CAReS staff.
- Ensures medical record integrity and participates in informal internal audits and external formal audits as directed by the Integrated Behavioral Healthcare Manager.
- Coordinates client care with community partners and referral sources.
- Attends community partnership meetings as assigned by the Integrated Behavioral Healthcare Manager.
- Attends staff meetings, trainings, and seminars as requested.
- Performs other related duties as required/assigned.
Minimum Requirements
- Behavioral Health Agency Integrated Healthcare Quality Supervisor:
- Must be designated as a Mental Health Professional with the knowledge and skills to complete full diagnostic assessments with the ability to formulate DSM 5 diagnoses.
- Possess a valid State of Washington issued credential to practice as an independent licensed clinician, without restriction, probation, or limiting condition or threat thereof, or proof of application must be provided within 30 days of beginning employment.
- Possess a valid National Provider Identification Number (NPI) or proof of application must be provided within sixty (60) days of beginning employment.
- Maintain professional credentials required for the service being provided. Including CEU credits as needed to maintain credentials.
- Have documentation of training and competency in clinical supervision in compliance with WAC 246-809-234.
Selection Factors
- Knowledge of principles and practices of continuous quality improvement.
- Knowledge of relevant federal, state, and county policies, procedures, and regulations to include HIPAA and 42 CFR, Part 2.
- Knowledge of the CSRBH Service Encounter Reporting Instructions with the ability to provide technical assistance to contracted behavioral health agencies as needed.
- Knowledge of best practice standards for acute psychiatric symptoms, diagnoses, and treatment.
- Knowledge of best practice standards for substance use disorder symptoms, diagnoses, and treatment.
- Knowledge of managed care and utilization review required.
- Knowledge of the relevant system of care for Adams, Ferry, Lincoln, Pend Oreille, Spokane and Stevens Counties.
- Knowledge of fundamental understanding of DSM 5, or its successor, psychiatric disorders, psychotropic medications, brain physiology, and demonstrate a working knowledge of the various theoretical models of psychotherapy, behavioral counseling and other Evidence Based Practice treatment.
- Knowledge of contract administration and compliance.
- Knowledge of group facilitation skills towards consensus based and target outcomes.
- Knowledge of public and private behavioral health providers and community resources and programs available to individuals with identified needs.
- Knowledge of collaborative case planning and care coordination.
- Knowledge of person-centered treatment and recovery models.
- Knowledge of techniques for dealing with a variety of individuals from various socio-economic, ethnic, and cultural backgrounds, in person and over the telephone.
- Knowledge of programs and eligibility requirements for the Social Security Administration, Washington State Medicaid, regional social services and food stamps, and other relevant programs.
- Knowledge of the basic principles of pro-active supervision, including but not limited to assigning workload, evaluating and supervising staff, and developing performance improvement plans for employees.
- Knowledge of project management tools and techniques to achieve detailed integration of processes, systems and people.
- Knowledge of application and effectiveness of multidisciplinary behavioral health treatment modalities including best practices services model(s) used in a comprehensive community-based behavioral health program.
- Knowledge of program planning, development, implementation, monitoring, evaluation principles and techniques and technical assistance required in coordinating large complicated functions such as community behavioral health and substance use disorder programs.
- Knowledge of supervisory practices and procedures in a union environment.
- Knowledge of relevant Federal and State laws, rules and regulations, the legislative process, policy and budget governing the operation and administration of community mental health and substance abuse programs.
- Knowledge of community social services organizations and the structure and function of DSHS offices and divisions involving appropriate federal, state, and local laws, regulations, and ordinances.
- Skilled in communicating effectively both orally and in writing, sufficient to exchange or convey information and to give and receive work direction.
- Skilled in establishing and maintaining effective working relations with all personnel, including, federal and state agencies, local government agencies and associations, and community and development service agencies and committees.
- Skilled in planning and organization with ability to track and meet varying deadlines.
- Skilled in understanding politically sensitive and/or controversial issues.
- Skilled in public speaking.
- Skilled in the use of personal computers, including proficiency with Microsoft Products: Word, Excel, PowerPoint, Visio, SharePoint, Project, and other learning tools.
- Ability to work independently in developing and managing a range of complex projects and programs.
- Ability to develop, implement and administer goals, objectives and procedures for providing effective and efficient services.
- Ability to train, supervise and effectively direct activities of professional staff.
- Ability to interpret, review and understand complex reports and regulatory requirements.
- Ability to conduct public meetings and effectively present information, both orally and in writing.
- Ability to deal with the public in a pleasant, courteous and calm manner, often under stressful and/or emergent situations.
- Ability to make decisions and use good judgment to solve complex technical or political problems in consultation with the Integrated Behavioral Healthcare Manager.
- Ability to apply clinical judgment, ethics, and accountability to formulate and implement treatment plans and other clinical documentation.
- Ability to analyze problems, identify solutions and project consequences of proposed actions and implement recommendations in support of goals and objectives.
- Ability to effectively supervise projects through to completion and according to established deadlines.
- Ability to analyze data and prepare comprehensive plans and grant justifications.
- Ability to interpret and apply applicable Federal, State and local laws, rules, regulations and ordinances.
- Ability to communicate effectively in writing, including the preparation of administrative, technical and statistical reports.
- Ability to apply standardized Medical Necessity Criteria to determine lengths of stay and continued care.
- Ability to efficiently refer to and effectively utilize County funded community resources for the least restrictive level of care.
- Ability to analyze, interpret, apply, and explain utilization data.
- Ability to assess cases appropriately and utilize the most appropriate community resources to provide effective client services.
- Ability to prepare clear and concise reports, correspondence, and other written materials.
- Ability to use initiative and independent judgment within established procedural guidelines; organize own work, set priorities, and meet critical deadlines.
- Ability to establish and maintain effective working relationships with those contacted in the course of the work.
- Ability to perform all related duties with accuracy and efficiency.
SPOKANE COUNTY
Employee Benefits Summary
The following is a brief list of benefits available to Spokane County regular employees. Complete information is available from Human Resources Department. This information is subject to change.
PAID TIME OFF
Spokane County Observed Holidays
Up to 10 (ten) paid holidays are observed by Spokane County.
PTO
Non-represented and a select group of represented employees receive a bank of hours that combine both vacation and sick leave into a paid time off bank. There is no waiting period to use this time and it starts out at almost 2 days per month accrual increasing in accrual rates annually for first 5 years.
Vacation
For employees with less than five (5) years of continuous service, the accrual rate is 1 day of vacation each month for a total of 12 days per year. After six (6) months, employees are eligible to take accumulated vacation time. (Please note the vacation time accumulation may vary depending on contract language).
Sick Leave
Sick leave is earned at 1 day per month and can be taken as the days are accumulated.
Other Leaves
Spokane County provides several other paid leaves such as: bereavement leave, jury duty and military duty leave.
INSURANCE BENEFITS
Medical Insurance
Two plans are currently available: Premera Blue Cross (PPO) and Kaiser Permanente (HMO). Spokane County pays 95% of the premium for full-time employees and 90% of the premiums for spouses and dependents. Premiums are deducted each pay period (pay periods: 15th and last day of the month).
2023 Rates:
Premera
Employee Only: $38.04 per month
Employee & Spouse: $149.52 per month
Employee & Family: $209.60 per month
Employee & Child(ren): $136.16 per month
Kaiser:
Employee: $35.92 per month
Employee & Spouse: $140.56 per month
Employee & Family: $196.06 per month
Employee & Child(ren): $128.58 per month
Dental Insurance
Two plans are currently available: Delta Dental of Washington (PPO) and Willamette Dental (DMO). Spokane County pays 95% of the premium for full-time employees and 90% of the premiums for spouses and dependents.
2023 Rates:
Delta Dental Willamette Dental
Employee: $5.74 per month Employee: $5.98 per month
Family: $11.48 per month Family: $11.96 per month
Group Life Insurance
The County provides a $25,000 group life insurance policy to employees. The County provides a $10,000 benefit for those represented by 492, 492CS & 492CL. This benefit is paid in full by Spokane County.
Long Term Disability Coverage
Provides an income protection benefit in the event of a long-term illness or injury at rate of 60% of income up to a maximum of $5,000 per month. Spokane County pays the full premium for this plan. Deputy Sheriff's receive a benefit through their union for disability.
RETIREMENT
Retirement Plan (401a)
Spokane County employees are automatically included in the Washington State Retirement System. Both the employer and the employee contribute to the plan. This retirement plan provides a guaranteed lifetime monthly benefit once vested and eligible for retirement.
Additional Retirement Plan Option (457b)
Employees may supplement their retirement income and save money on taxes by participating in this optional County program. Roth (after-tax) option is also available through this retirement plan.
VOLUNTARY BENEFITS
AFLAC
Supplemental insurance is optional and is provided by AFLAC to help pay for benefits not covered by major medical insurance. The employee pays 100% of the premium.
Travel Assistance
Provides additional travel protections anytime you travel more than 100 miles from home. Includes pre-trip information, emergency ticket replacement, and emergency evacuation coverage. This benefit is paid in full by Spokane County.
Flexible Spending Plan (FSA)
Spokane County sponsors a Section 125 Flexible Spending Account to allow out-of-pocket Medical & Daycare Expenses to be paid with Tax Free Dollars. Premiums are automatically set up pre-tax under the FSA.
Voluntary Term Life Insurance
Voluntary Term Life Insurance is additional optional life insurance provided through The Standard Insurance. New employees are guaranteed up to $50,000 for self and $20,000 for a spouse with no medical underwriting needed.
WORK/LIFE PROGRAMS
Employee Assistance Program
Employees and their family members are eligible to receive free counseling. There are also benefits relating to financial and legal concerns.
Reduced Cost Bus Pass Program
Spokane County participates in a program with STA which discounts bus passes to $5 a month.
Wellness Programs
There are opportunities for nearby exercise programs at reduced cost and education programs around wellness themes including financial well-being, nutrition and stress reduction.
Discounts
There are local and national discounts available to Spokane County employees.
Agency
Spokane County
Address
824 N Adams
Spokane, Washington, 99260
Phone
509-477-5750
Website
http://www.spokanecounty.org/employment
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