Job: Quality Assurance Clinical Review Specialist

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Job Description

Job Description

Hillsides is dedicated to healing children and young adults, strengthening families, and transforming communities through quality comprehensive services and advocacy.

In exchange for your skill and experience, Hillsides offers an excellent benefits package, which includes:

  • Competitive salary
  • Supportive work environment

  • Medical insurance  with a $10 premium per paycheck for employee only coverage plan

  • Dental insurance 100% employer paid for HMO employee only coverage plan

  • Life and AD&D insurance 100% employer paid up to two times the annual salary

  • Long-term disability 100% employer paid 

  • Flexible Spending Account with $500 roll-over limit    

  • 401 k with no wait period, 5% employer match cap and no vesting schedule

  • 12 paid holidays per year

  • Generous time off policy accruing up to 22 paid days in a year for new employees 

  • Cell phone allowance for applicable position 

  • Employee Assistance Program

ESSENTIAL FUNCTIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  Other duties may be assigned.

The essential functions include:

  • Oversee contract compliance (i.e. attending meetings, communicating/coordinating with Hillsides program managers/directors, training new staff, progress note/document reviews and audits, etc.)
  • Work in conjunction with directors from programs to ensure training/support to contracted Outpatient Psychiatrists regarding DMH documentation compliance.
  • Train and support QA Associates with Welligent and clinical documentation
  • Review and approve the fidelity of the clinical model of Hillsides governing bodies (assessments, client treatment plan, discharge summary, annual paperwork, diagnosis updates, etc.), and request/oversee Correction Action Plan (CAP) from clinical staff, including contracting psychiatrist, when fidelity is non-compliant
  • Review the coordination of progress note review, and approve clinical progress note review to comply 90 days after clinical supervisor review, and oversee CAP from clinical staff, including contracting psychiatrists.
  • Make independent decisions and report those findings regarding the fidelity of the "Clinical Loop".
  • Assist QA Department in maintaining compliance with regulations regarding the governing bodies of Community Care Licensing (Title 22), Counsel on Accreditation (COA), Medi-Cal Certification, Licensure, and Accreditations
  • Assist and provide compliance with regulations during New Hire Orientation clinical training, and drop in documentation workshops
  • Attend DMH, DCFS, WASC, COA, meetings assigned
  • Assist in Welligent Activities
  • Prepares and submits detailed reports as needed
  • Participate in audit preparation
  • Provide on going communication with staff regarding documentation
  • Provide support during chart reviews as needed
  • Tracks quality control issues in appropriate computer database(s)
  • Attend staff quality assurance meetings
  • Prepare for meetings and record meeting minutes as needed
  • Copy documents as needed
  • Relieve front desk receptionist as needed
  • Participate in clinical training to update on clinical documentation standards
  • Participate in special project
  • Other duties as required

SKILLS AND ABILITIES REQUIRED TO PERFORM THE ESSENTIAL JOB FUNCTIONS:

 Communication Skills and Abilities:

  • Ability to effectively present information and respond to questions from clients,  office personnel, other employees and the general public
  • Ability to read, analyze and interpret manuals and office documents
  • Ability to speak a language other than English if required
  •  Mental/Interpersonal Skills and Abilities:
  • Ability to define problems, gather, transcribe and post data, analyze, synthesize and classify information, and draw valid conclusions
  • Ability to work independently and with others – including other employees, clients and members of the public -- in face-to-face and telephonic contexts
  • Ability to multi-task, establish priorities and manage time, meet deadlines and perform duties under time constraints
  • Ability to be flexible and adapt to changing work demands
  • Maintain high level of concentration and attention to detail for extended periods of time
  • Ability to respond effectively to sensitive inquiries or complaints
  • Maintain a high level of ethical and professional standards in accordance with agency and community policy

 Physical Skills and Abilities:

  • Ability to talk or hear in order to give and receive information and instructions
  • Ability to stand, walk, sit, use hands to finger, handle or feel objects, tools or controls
  • Ability to reach with hands and arms
  • Ability to use computer keyboard up to 50% of the day
  • Visual acuity, ability to adjust focus and peripheral vision for work on a laptop or other computer equipment
  • Lift and/or move up to 10 pounds 

Equipment and Computer Software Skills and Abilities:

  • Computer literate (basic working knowledge of Microsoft WORD, Excel, and Outlook), data/electronic records program in use, and other applications related to billing of services

  • Able to use telephone, office copier, calculator, fax machine, computer printer and scanner, or other equipment as required

WORK ENVIRONMENT:

  • Regularly work indoors in a variety of environments
  • Potential exposure to blood born pathogens

EDUCATION, EXPERIENCE& CERTIFICATES  

  • Masters degree from an accredited or state approved program degree
  • Four years experience with EPSDT related documentation and Short Doyle Medi-Cal
  • Knowledgeable of the prevailing governmental laws and regulations regarding the provision of mental health services, including confidentiality and limits thereof, the reporting of child abuse/neglect, and related regulations
  • Knowledgeable of and acts in accordance with Ethical and Professional Standards established by appropriate professional organizations, whether or not the individual is a member of any such organization
  • Must have skills necessary to engage and work with others from diverse backgrounds
  • Able to maintain a non-judgmental attitude toward youth and families
  • Valid California drivers license, driving record and personal vehicle insurance acceptable to Hillsides’ insurance carrier

Hillsides is an Equal Opportunity Employer

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