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QUALITY AND COMPLIANCE SPECIALIST
Under the general supervision of the Outpatient Medical Director and Clinic Director, the Quality and Compliance Specialist is responsible for performing all duties associated with evaluating and monitoring the Quality of care at the DWIHN Community Care Clinic.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
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``` - Interprets, formulates and maintains continuous quality improvement (CQI) and assurance programs and performs quality assurance reviews designed to ensure quality services consistent with national industry standards, compliance and state regulations. - Creates performance improvement projects based on quality analysis. - Compiles the annual CQI Plan for submission. - Prepares quality documentation and reports by collecting, analyzing and summarizing information and trends including failed processes, stability assessments, corrective actions, and validations. - Reviews quality outputs for compliance (internally and externally). - Conducts utilization reviews, productivity and policy analyses using statistical process methods. - Assures that clinic policies meet PIHP, State, Federal, Joint Commission and all other accreditation standards. - Reviews agency and State policies and ensures consistency in implementation. - Analyzes and tracks productivity and performance levels and consistently assesses ways to improve DWIHN programs. - Prepares regular reporting based on organization and certification related requirements. - Interprets, applies and recommends changes to organizational policies and procedures.
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``` - Works with department supervisors to identify specific quality program objectives or problems, recommends system improvements, and monitors the approved changes. - Conducts thorough internal investigations, gathering, and analyzing relevant data, interviewing key stakeholders, and ensuring compliance with company policies and legal regulations to identify potential issues and recommend corrective actions. - Monitors HEDIS measures for compliance and creates improvement plans as applicable. - Recommends practices, productivity, quality, and customer-service standards.
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``` - Validates quality processes for each program by establishing product specifications and quality attributes; measuring tools; documenting evidence; determining operational and performance qualifications; and writing and updating quality assurance procedures. - Completes incident reports, critical and sentinel event reporting, root cause analysis and improvement plans as applicable. - Prepares the clinic and programs for accreditation such as Joint Commission and lead site reviews. - Performs fidelity analysis for Evidence based practices. - Coordinates and manages CCBHC data and evaluation activities including the development of study protocols, databases, and data collection workflows for qualitative and quantitative analyses. - Drafts written reports and presentations related to evaluation processes and findings. - Develops data collection protocols and instrumentation necessary to conduct in-depth studies.
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``` - Aggregates and presents performance/evaluation data to leadership and the care team on a monthly or quarterly basis.
Develops and trains staff on protocols, procedures, and policies related to collection of data and compliance standards.
Works with a cross-functional team to define and develop analysis plans, ensure data quality standards and creates