County Quality Assurance/Risk Management Specialist                                                                                                                                                                          L0758

Definition: This is professional staff work specializing in quality assurance/risk management monitoring and evaluation activities of county and/or provider agency mental health and intellectual disability services to ensure that they meet regulatory standards.

An employee in this class consults and collaborates with interdisciplinary clinical and nonclinical mental health and intellectual disability county and/or provider agency support staff, consumers and various community members in the monitoring and evaluation of quality assurance and risk management program activities in a county or joinder setting. Work involves interpreting applicable state and federal policies, regulations and legislation for quality of patient cares services; analyzing, evaluating and summarizing quality assurance and risk management data; and identifying possible liability problems and issues of noncompliance with regulatory requirements. Work includes monitoring, examining and evaluating records of patient care, incident reports, medication reports, third party payor reports, administrative policies and practices, and practitioner credentials; investigating staff complaints and patient abuse reports; inspecting physical plants for compliance with life safety code and sanitation requirements; identifying therapeutic environment deficiencies; and tracking progress of problem solving and monitoring activities for the implementation of actions to correct operating deficiencies. Important aspects of the work are conducting surveys; recommending possible solutions to problems and development of methods to prevent or correct potential liability and/or operating deficiencies and cooperating with independent third party certifying and accreditation surveying agencies. Work is performed under the general supervision of the County Mental Health/Administrator or other administrative supervisor and is reviewed for conformance with established criteria, standards and procedures as set forth in the county or joinder quality assurance and risk management plan and applicable state and federal rules, regulations, policies and procedures through conferences, reports and evaluation of results achieved.

Examples of Work: Interprets applicable state and federal policies, regulations and legislation for quality of patient care services.

Consults and collaborates with interdisciplinary clinical and nonclinical mental health and intellectual disability county and/or provider agency support staff, consumers and various community members engaged in monitoring and evaluating the county or joinder quality assurance and risk management program activities to assure the appropriateness and quality of patient care provided meets regulatory requirements.

Analyzes and evaluates patient/staff incident reports, records of patient care and nutrition needs, medication reports, third party payor reports, administrative policies and practices and practitioner credentials and identifies potential liability problems and issues of noncompliance with regulatory requirements.

Provides direction and support to a county or joinder wide Quality Enhancement/Assurance Committee, comprised of consumers and community members, charged with designing and implementing statistical tools to plan, and assess services; annually evaluate programs; and implementing and maintaining quality assurance standards.

Meets with mental health and intellectual disability advocacy groups and other consumers as needed to assist with advocacy planning, implementation/evaluation; attends public meetings and hearings to encourage input to program plans and evaluations by seeking participation in the annual plan process.

Participates in surveys with interdisciplinary clinical and nonclinical administrative and support services staff to identify potential problem areas, recommends methods and actions to prevent and/or correct staffing and/or operating deficiencies, and monitors follow-up activity reports to ensure timely and appropriate actions are taken to minimize and/or prevent problem reoccurrences.

Investigates reported problems related to county and/or provider agency patient care systems and operations, safety of patients and staff, injury reports and patient complaints and abuse; recommends appropriate actions; provides guidance and assistance to staff to correct deficiencies; and prepares written and oral reports on problem/deficiency resolution.

Participates in the organization and coordination of independent third party surveys conducted by certifying and accrediting agencies for compliance with state and federal regulations and legislation by completing required pre-survey forms and assembling documentation and records for review by surveyors, and accompanying them on the on-site review.

Provides input to and assists in the implementation and monitoring of action plans to minimize liability problems and to correct deficiencies identified by independent survey teams.

Prepares reports and maintains files and records of quality assurance/risk management monitoring and evaluation activities and completed studies.

Performs related duties as required.

Required Knowledges, Skills, and Abilities: Knowledge of federal and state regulations, rules, policies and procedures relative to the quality assurance/risk management program.

Knowledge of medical and psychiatric terminology, appropriate levels of patient care and treatment, health and nutrition care delivery systems and practitioners’ credential requirements.

Knowledge of principles and practices of health care administration pertaining to quality assurance/risk management patient care services.

Ability to interpret policies, procedures, rules and regulations applicable to the quality assurance/risk management program.

Ability to interpret, analyze, and evaluate nonclinical and clinical care practices, including patient care, treatment and nutrition records, medical records and health services management records to determine the appropriateness and quality of care and services provided for patients.

Ability to collect and record information and to identify potential and/or actual liability problems and issues of noncompliance with regulatory requirements.

Ability to establish and maintain effective working relationships with interdisciplinary clinical and nonclinical administrative and support services staff engaged in quality assurance/risk management program activities.

Ability to provide guidance and technical assistance to county and/or provider agency staff on the governing quality assurance/risk management regulation requirements and to recommend and assist them in correcting operating deficiencies.

Ability to prepare reports and to express ideas clearly and concisely, orally and in writing.

Minimum Experience and Training: Two years of professional experience as a member of a multiple disciplinary treatment team in a public or private health care facility and a bachelor’s degree;

Or

Two years of clinical experience in a human services agency, including one year of administrative, evaluative, or consultative experience in a health care program; and a bachelor’s degree with major course work in social work, nursing, health care administration, behavioral sciences or a related field;

Or

Any equivalent combination of experience and training which includes two years of clinical experience in a human services agency, including one year of administrative, evaluative, or consultative experience in a health care program.

Commonwealth Equivalent PSG ST07