Quality and Compliance Specialist

Under the general supervision of the Outpatient Medical Director and Clinic Director, the Quality and Compliance Specialist is responsible for performing all duties associated with evaluating and monitoring the Quality of care at the DWIHN Community Care Clinic.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Ensures compliance with all applicable State and Federal requirements and promotes safety, quality and effective service delivery.
• Oversees data collection, monitoring, analysis, and reporting systems in compliance with the PIHP and State requirements.

• Interprets, formulates and maintains continuous quality improvement (CQI) and assurance programs and performs quality assurance reviews designed to ensure quality services consistent with national industry standards, compliance and state regulations.
• Creates performance improvement projects based on quality analysis.
• Compiles the annual CQI Plan for submission.
• Prepares quality documentation and reports by collecting, analyzing and summarizing information and trends including failed processes, stability assessments, corrective actions, and validations.
• Reviews quality outputs for compliance (internally and externally).
• Conducts utilization reviews, productivity and policy analyses using statistical process methods.
• Assures that clinic policies meet PIHP, State, Federal, Joint Commission and all other accreditation standards.
• Reviews agency and State policies and ensures consistency in implementation.
• Analyzes and tracks productivity and performance levels and consistently assesses ways to improve DWIHN programs.
• Prepares regular reporting based on organization and certification related requirements.
• Interprets, applies and recommends changes to organizational policies and procedures.

• Works with department supervisors to identify specific quality program objectives or problems, recommends system improvements, and monitors the approved changes.
• Conducts thorough internal investigations, gathering, and analyzing relevant data, interviewing key stakeholders, and ensuring compliance with company policies and legal regulations to identify potential issues and recommend corrective actions.
• Monitors HEDIS measures for compliance and creates improvement plans as applicable.
• Recommends practices, productivity, quality, and customer-service standards.

• Validates quality processes for each program by establishing product specifications and quality attributes; measuring tools; documenting evidence; determining operational and performance qualifications; and writing and updating quality assurance procedures.
• Completes incident reports, critical and sentinel event reporting, root cause analysis and improvement plans as applicable.
• Prepares the clinic and programs for accreditation such as Joint Commission and lead site reviews.
• Performs fidelity analysis for Evidence based practices.
• Coordinates and manages CCBHC data and evaluation activities including the development of study protocols, databases, and data collection workflows for qualitative and quantitative analyses.
• Drafts written reports and presentations related to evaluation processes and findings.
• Develops data collection protocols and instrumentation necessary to conduct in-depth studies.

• Aggregates and presents performance/evaluation data to leadership and the care team on a monthly or quarterly basis.

• Develops and trains staff on protocols, procedures, and policies related to collection of data and compliance standards.
• Works with a cross-functional team to define and develop analysis plans, ensure data quality standards and creates ready results.
• Develops and conducts surveys, key informant interviews and client focus groups.
• Oversees member satisfaction surveys in collaboration with Customer Service.
• Conducts advanced statistical analysis including descriptive and inferential statistical analysis.
• Oversees the development of written and oral interim and final evaluation reports.
• Utilizes a systematic method to collect and analyze data and identify gaps and areas of strength.
• Designs advanced analytics dashboards displaying key metrics, clinic/CCBHC real-time performance and Key Performance Indicator (KPI) reports to track outcomes and flag areas for improvement.
• Ensures that confidentiality and data security safeguards are integrated into data management, storage and analysis protocols, activities, and output.
• Prepares grant progress reports and presentations for internal and external audiences.
• Collaborates with EHR team and quality assurance to create new enhancements and upgrade data entry and data production processes.

• Performs related duties and responsibilities as assigned.

KNOWLEDGE, SKILLS AND ABILITIES

• Knowledge of DWIHN policies, procedures and practices.
• Knowledge of the principles of quality improvement.
• Knowledge of Utilization Management.
• Knowledge of Critical/Sentinel Event policies and procedures.
• Knowledge of Quality Assurance.
• Knowledge of accreditation and certification standards related to the provision of mental health, developmental disability and substance use disorder services.
• Knowledge of the DWIHN provider network.
• Knowledge of medical and behavioral health practices and terminology.
• Knowledge of compliance standards.
• Knowledge of the Medicaid screening process.
• Knowledge of MDHHS policies, rules, regulations and procedures.
• Knowledge of health care fraud and abuse laws, including the False Claims Act, Stark Laws, and the Anti-Kickback Statute, including the associated penalties.
• Knowledge of health care law, regulations and standards.
• Knowledge of governmental compliance regulations.
• Knowledge of NCQA requirements and the accreditation process.
• Knowledge of contracting policies and procedures.
• Knowledge of Quality Management and Improvement principles and practices.
• Knowledge of HIPPA Compliance.
• Corrective Action skills.
• Computer skills.
• Time management skills.
• Organizational skills.
• Critical thinking skills.
• Teamwork skills.
• Conflict Resolution skills.
• Decision Making skills.
• Project Management skills.
• Assessment skills.
• Report writing skills.
• Communication skills.
• Multitasking skills.
• Analytical skills
• Ability to communicate orally.
• Ability to communicate in writing.
• Ability to work effectively with others.
• Ability to work with an ethnically, linguistically, culturally, economically and socially diverse population.
• Judgement/Reasoning ability

REQUIRED EDUCATION:

A Doctorate or Master's degree from a recognized college or university in the Human Services, the Social Services, Nursing (a Bachelor's Degree will be accepted), Public Health, Public Administration, Healthcare Administration, Health Management, Epidemiology or a related field.

REQUIRED EXPERIENCE:

Four (4) years of professional experience in a behavioral healthcare or mental health setting including two (2) years of professional experience in the following:

• Quality Management and Accreditation.

AND

• Statistical analysis of health care data, metrics, systems and standards.
• Experience creating and implementing a Hazard Vulnerability Analysis (HVA) with a clear Emergency Management Plan involving Mitigation, Preparedness, Response and Recovery.
• Experience as a supervisor, manager, administrator or executive.
• Experience working with SAMSHA grants.

REQUIRED LICENSE(S)

A valid State of Michigan Driver's License with a safe and acceptable driving record.

Certified Professional in Healthcare Quality certification preferred.

WORKING CONDITIONS:

Work is usually performed in an office setting but requires the employee to drive to different sites throughout Wayne County and the State of Michigan.

This description is not intended to be a complete statement of job content, rather to act as a general description of the essential functions performed. Management retains the discretion to add or change the position at any time.

Please Note: DWIHN requires proof of being fully vaccinated for COVID-19 as a condition of employment. Medical or religious accommodations or other exemptions that may be required by law, will be approved when properly supported. Further information will be provided during the recruitment process.

The Detroit Wayne Integrated Health Network is an Equal Opportunity Employer