Summary of Duties:
Verifies accurate data documentation and analyzes participant files to ensure program compliance. Provides utilization and quality review for the AAA on an ongoing basis. Conducts and coordinates a variety of quality assurance/quality improvement functions to ensure compliance with regulatory mandates and NCQA accreditation. Creates tools and forms to increase efficiency of work flows. Serves as a supervisor to provide oversight of employee performance on outcome measures. Provides direct supervision to field staff in designated office locations, provides input and data trends on staff performance for employee evaluations and identifies staff training needs based on data analysis and develops appropriate curriculum for staff. Assist in the development and enforcement of internal policies and staff monitoring.
What You'll Do: Other duties may be assigned.
- Maintain a working knowledge of regulations and procedures for Care Management, MI Choice Waiver Program and other human service programs, private insurance and third party reimbursement systems;
- Serve as liaison to organizations to ensure resolution of client eligibility issues and maintain positive working relationships with all agencies/organizations in conducting AAA business;
- Advise staff regarding participant issues in relation to regulations and procedures of home and community based service programs;
- Monitor quality assurance activities for community based care programs and monitor teams to ensure resolution of any problems relating to eligibility or quality;
- Conduct program presentations and represent the agency at state, federal and local meetings as needed;
- Coordinate and develop training opportunities for staff and providers based on quality analysis;
- Coordinate and develop training opportunities for staff and providers based on quality analysis;
- Assist the Associate AAA Director with interpretation of contracts and writing of local policy;
- Act as back up to community based care field staff
Supervisory Duties:
- Provides direct supervision to field staff in designated office locations;
- provide oversight of employee performance on outcome measures
- Provides input and data trends on staff performance for employee evaluations
- Identifies staff training needs based on data analysis and develops appropriate curriculum for staff
- Routinely review staff paperwork and case files
- Perform site visits with staff and ensure clinical protocols and standards are met the purposes of quality management;
- Review Files, provide case consultation, in-home supervisory visits, etc to ensure compliance with CBC program standards
- Assist in the recruitment and training of new staff. Assist with payroll and accounts payable processing.
- Communicate to staff regarding issues with quality assurance and provide direction to mitigate errors
- Monitor and verify Participant care plans, medical eligibility and service costs to ensure program compliance, quality care and appropriate service costs. Review documentation in databases.
- Participate in on-going communication with the associate AAA director to ensure program compliance
- Participate in activities for the associate AAA director in their absence
- Coordinate and conduct CBC program peer review
- Ensure data collection, analyzation, and reporting of quality activities are conducted to include analyzation of data, database maintenance, follow up to ensure Supports Coordination(SC) staff addresses issues, trend analysis, communication with appropriate SC staff, supervisors and CBC Associate Director. May require case reviews to determine cause of compliance issue, hospitalizations, etc. Reporting schedule
Supervisory Responsibilities:
This position supervises the Community Based Care Supports Coordinators and Intake Specialist.
Education and Experience:
Registered Nurse or Licensed Social Worker and one to three years experience working with the elderly and/or disabled and an extensive background in quality management required. BSN preferred.
Certificates, Licenses, Registrations:
Employees in this position must possess reliable transportation and a valid Michigan Driver License.
