QM Specialist - #196520

ChangePoint Integrated Health Centers


Date: 06/08/2022 06:30 AM

City: Show Low, Arizona

Contract type: Full Time

Work schedule: Full Day

JOB DESCRIPTION
TITLE: QUALITY MANAGEMENT/UTILIZATION MANAGEMENT SPECIALIST (QM/UM SPECIALIST)
STATUS: NON-EXEMPT
LINES OF AUTHORITY: This position is supervised by the Quality Manager. This position does not supervise staff but works collaboratively with supervisors to provide feedback regarding utilization management for the hospital, quality management and clinical record information for ChangePoint Integrated Health.
POSITION SUMMARY: This position is responsible for conducting record reviews for records release and for monitoring compliance with regulatory agencies and assisting in with the monitoring of the hospital's QM Plan, UM Plan, and ChangePoint's QM Plan at the direction of the Director of Quality Management.
PRINCIPLE DUTIES/RESPONSIBILITIES:
1. Adhere to personnel policy and comply with agency requirements for ethical
and professional behavior.
** 2. Participate in the implementation of the QM System, and assist in the
development of the annual Evaluation and Plan.
3. Participate in the implementation of the hospital's QM and UM system, and
assist in the development of the annual Evaluation and Plan.
4. Assist in the development and revision of policies and procedures as
needed.
5. Be a resource to clinicians and other administrative staff in regards to basic
regulatory record standards including OBHL, ADHS/DBHS, HCIC, TJC, AHCCCS, Medicare.


6. Able to produce verbal and written reports, and visual graphs to reflect data analysis.
7. Work as team player assisting staff with various skill levels and backgrounds to understand and comply with record standards.
8. Must be accurate, efficient and complete in documentation.
9. This position requires positive and active support of the company,
Patients, families and co-workers.
10. Must participate in quality management and quality improvement activities.
11. Responsible for performing chart reviews and chart audits as needed.
12. Responsible for the review and release of medical records, ensuring that all HIPPA rules and regulations are adhered to in the process.
13. Promotes quality and safety to help maintain a safe and pleasant work
environment, follows safety regulations, and actively contributes towards a
safe workplace.
14. Perform other duties as assigned by supervisor.
PRIMARY CONTACTS:


Regular review of clinical records (electronic and written).
Interface regularly with Chief Operations Officer, Hospital Administrator, Medical Director, Quality Manager, Compliance Director and other supervisors.
Periodic interface with regulatory and accrediting bodies/employees.
POSITION REQUISITES:
Qualifications and Experience
Required:
High School Diploma
Current Arizona Driver's License.
One year experience working for a behavioral health agency.
Comply with a Drug Free workplace.
Fingerprint Clearance.
Must be 21 years of age.
Preferred:
BHT possessing a Bachelor's Degree or higher
Two years of experience working for a behavioral health agency.
Skills/Abilities
Required:


Able to work within a multi disciplinary structure.
Able to employ Quality Management theory and techniques.
Strong verbal and written communications skills.
Basic knowledge of resources related to regulations.
Strong organizational and time management skills.
Able to interact effectively with supervisors and employees.
Fluent in English both verbally and in writing.
Literate.
Able to effectively employ analytical and problem-solving skills.
Ability to work forty (40) hours per week.
Able to use various computer software programs to produce high quality report and graphs, tables.
WORKING CONDITIONS:
Physical Requirements
Able to sit and stand for extended periods of time, less frequently, walking, lifting
and reaching.
Able to hear ordinary conversation and phone communications.
Visual capacity necessary to fulfill documentation, responsibilities of job.
Negative TB skin test.


Emotional Capabilities
Able to provide verbal and written feedback, including negative feedback, to employees and supervisors related to clinical record reviews and other QM monitors.


Equipment Operation
Able to operate general office equipment, including computers.
Able to operate Company vehicles.


Environmental Conditions
Air conditioned and/or heated office setting.


Accommodations(s)
Will accommodate as appropriate and reasonable.
CONFIDENTIALITY LEVEL:
I understand that State and Federal Laws strictly prohibit unauthorized access, use, modification, disclosure, or destruction of confidential, sensitive or protected health information. Penalties for violation may include ChangePoint disciplinary action, including termination of employment, and/or criminal or civil action.


Job Title


Quality Management Specialist


Job Code


Status


Hourly non-exempt


Lines of Authority


This position is supervised by the Quality Manager. This position does not supervise staff but works collaboratively with supervisors to provide feedback regarding utilization management, quality management and clinical record information for ChangePoint Integrated Health


Position Summary
This position is responsible for conducting record reviews for records release and for monitoring compliance with regulatory agencies and assisting at ChangePoint Integrated Health. The position performs clinical and operational audits as a means of verifying accuracy of information and compliance to established policies, practices, and regulations. Assist with the investigation, inspection, program evaluation, education case finding and prevention.
Duties and Responsibilities
? Adhere to personnel policy and comply with agency requirements for ethical and professional behavior
? Performs monthly, quarterly, annual and ad hoc medical record reviews
? Assists with potential quality of care concerns including but not limited to conducting investigations and tracking and trending to identify opportunities for improvement.
? Works collaboratively with department personnel to gather data reporting requirements, integrate data across multiple sources, build data associations when necessary and provide information needed for data-driven decisions.
? Able to produce verbal and written reports, and visual graphs to reflect data analysis.
? Work as team player assisting staff with various skill levels and backgrounds to understand and comply with record standards.
? Must be accurate, efficient and complete in documentation.
? This position requires positive and active support of the company, patients, families and co-workers.
? Must participate in quality management and quality improvement activities.
? Responsible for performing chart reviews and chart audits as needed.
? Responsible for the review and release of medical records, ensuring that all HIPPA rules and regulations are adhered to in the process.
? Promotes quality and safety to help maintain a safe and pleasant work environment, follows safety regulations, and actively contributes towards a safe workplace.
? Perform other duties as assigned by supervisor.
Primary Contacts
? Regular review of clinical records (electronic and written).
? Periodic interface with regulatory and accrediting bodies/employees.
Position Requisites
Qualifications and Experience
Required:
? High School Diploma
? Current Arizona Driver's License.
? Comply with a Drug Free workplace.
? Fingerprint Clearance.
? One-year Behavioral Health or Medical Office experience
Preferred:
? Associate degree or higher
? Two years of experience working for a behavioral health agency.
Skills/Abilities
Required:


? Able to work within a multi disciplinary structure.
? Able to employ Quality Management theory and techniques.
? Strong verbal and written communications skills.
? Basic knowledge of resources related to regulations.
? Strong organizational and time management skills.
? Able to interact effectively with supervisors and employees.
? Fluent in English both verbally and in writing.
? Literate.
? Excel experience
? Able to effectively employ analytical and problem-solving skills.
? Ability to work forty (40) hours per week.
? Able to use various computer software programs to produce high quality report and graphs, tables.


Working Conditions
Physical Requirements
? Able to sit and stand for extended periods of time, less frequently, walking, lifting
and reaching.
? Able to hear ordinary conversation and phone communications.
? Visual capacity necessary to fulfill documentation, responsibilities of job.
? Negative TB skin test.


Emotional Capabilities
? Able to provide verbal and written feedback, including negative feedback, to employees and supervisors related to clinical record reviews and other QM monitors.


Equipment Operation
? Able to operate general office equipment, including computers.
? Able to operate Company vehicles.


Environmental Conditions
? Air conditioned and/or heated office setting.


Accommodations(s)
? Will accommodate as appropriate and reasonable.
Confidentiality Level
I understand that State and Federal Laws strictly prohibit unauthorized access, use, modification, disclosure, or destruction of confidential, sensitive or protected health information. Penalties for violation may include ChangePoint disciplinary action, including termination of employment, and/or criminal or civil action.
I certify that I have read and understand my job description and the above Employee Confidentiality Statement
_____________________________________ ____________________
Quality Management Specialist Date
_____________________________________ ____________________
Supervisor Date


Job Type: Full-time

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