Community Partners, Inc.

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Quality Management/Licensing Specialist

at Community Partners, Inc.

Job Description

GENERAL SUMMARY:  

The QM/Licensing Specialist works closely with regional leadership and QM Director to oversee activities related to licensing, accreditation, quality improvement initiatives, reporting and mandated deliverables.    Prepares plans, reports and deliverables based on survey findings, performance improvement initiatives and health plan/contract deliverables.
 
JOB RESPONSIBILITIES:
  • Provides on-site consultation for plans of improvement, Corrective Action Plans and monitors progress towards reaching compliance.
  • Collaborates with Licensing Compliance Specialist to coordinate and/or participate in licensure and accreditation surveys, assisting with the assignment of staff members to various tasks during surveys.
  • Collaborates with Licensing Compliance Specialist to perform mock surveys, compliance checklists, etc. to ensure site readiness and demonstration of ongoing regulatory compliance.
  • Local point-of-contact to assist Licensing Compliance Specialist in the preparation of licensing Plans of Correction and Informal Dispute Request. May require coordinated input from appropriate staff. 
  • Conducts environmental, service-related, and medical record audits using established indicators.  Findings are reported to leadership and staff per a designated reporting schedule.
  • Understands all contract deliverables and timelines for submission.  Assists in completion of such deliverables and designates assignments as appropriate.  Ensures timelines are met and reports concerns regarding site performance.
  • Conducts and assists with training of staff on issues related to regulatory and contractual compliance, on deliverables, and on performance indicators.
  • Establishes the annual Quality Improvement Plan, with assistance from the Director of Quality Management and the Site Director.
  • Coordinates with Licensing Compliance Specialist annual site inspections for fire, sprinkler, alarm, extinguisher and gas systems to ensure safety and compliance.
  • Conducts drills as required by regulatory and accreditation entities. Maintains all records as required on site and with Licensing Compliance Specialist. 
  • Oversees the Incident Reporting process and can identify which incidents are only reported internally versus the IAD Portal.  Understands and participates in the review and responses needed to findings from mortality reviews and root cause analyses.
  • Completes monthly reporting to providers and clinical staff to ensure that all services have appropriate encounter and procedural codes.
  • Completes monthly reconciliation of the Mercy Care portal report and CPI Nextgen report to ensure accurate per member per month payment. 
  • Participates in the Culture of Safety Committee, and other committees as assigned.
  • Assists in the review and development of policies and procedures related to quality management, performance improvement, regulatory requirements, and safety.

 

 

Skill / Requirements

QUALIFICATIONS:

  • Education – Bachelor’s or Master’s degree in a related behavioral health field
  • Experience – Minimum three (3) years of behavioral health and/or quality management experience required. Previous experience with Electronic Medical Records preferred.
  • Regulatory
    • Minimum 21 years of age
    • Current, valid Arizona Driver’s License and 39 month Motor Vehicle Report to meet insurance requirements.
    • Eligible for DPS Level I fingerprint clearance.
    • First Aide, CPR certification (Employer provides). 

 CPIH is an equal opportunity employer.  CPIH does not discriminate based on age, ethnicity, race, sex, gender, religion, national origin, creed, tribal affiliation, ancestry, gender identity, sexual orientation, marital status, genetic information, veteran status, socio-economic status, claims experience, medical history, physical or intellectual disability, ability to pay, source of payment, mental illness, and/or cultural and linguistic needs, as well as any other class protected by law.

Application Instructions

CPIH utilizes an on-line application management system based on our Careers Page at our website.



Please access the system, create your profile, upload your resume, complete the application and indicate your interest in this opening at CPIH.