DCM Quality Analyst - Clearwater, FL

About the Role

Performs routine (journey-level) quality assurance work. Work involves planning, developing, and administering internal quality assurance and compliance activities. Works under moderate supervision, with limited latitude for the use of initiative and independent judgment. Provides physical presence in ensuring Supervisors are in compliance. Develops and oversees case compliance to prevent or address violations of policy and procedures.

Responsibilities

• Develops and implements quality assurance programs.
• Plans and organizes case review assignments.
• Conducts case and quality control reviews of programs.
• Verifies information received from case readings, sources, and clients.
• Participates in corrective action planning and service improvement activities.
• Identifies cases for investigation of potential fraud and for potential recoupment and restitution.
• Reviews and analyzes cases, notes deficiencies, and extracts data to be verified; collects performance data; identifies adverse trends; and determines compliance with service delivery standards, program requirements, and policies and procedures.
• Documents review findings.
• Communicates final determination of case review to appropriate staff.
• May analyze quality control error findings for trends or patterns.
• Assists with the development or implementation of compliance-related policies and procedures throughout the DCM Program.
• Handles communication, monitoring, or enforcement of all compliance standards.
• Reports violations of compliance or regulatory standards.
• Provides assistance to internal or external auditors in compliance reviews.
• Discusses emerging compliance issues with management and/or employees.
• Identifies compliance issues that require follow-up or investigation.
• Conducts scheduled internal reviews or audits.
• Conducts or directs the internal investigation of compliance issues.
• Performs related work as assigned.

Requirements

• Experience in social service financial eligibility determination, auditing, or investigating work.
• Graduation from an accredited four-year college or university with major coursework in computer science, computer programming, software engineering, or network administration or a related field is generally preferred.
• 3+ years of case management experience serving youth, individuals, and families in crisis.
• Experience with disaster and emergency services is a strong plus.
• Must maintain regular and acceptable attendance as determined by the employer.
• Must have a Driver’s License with a clear record.
• Must have daily use of a vehicle without prior notice.
• Must pass criminal and child abuse registry background checks.
• Must be available and willing to travel to various locations and with such frequency as business needs dictate, including deployment within 24 hours to disaster locations for as long as 2-4 weeks.
• Must be available and willing to work nights, weekends, and holidays as required to meet business needs.
• Must not pose a threat or significant risk of substantial harm to the safety or health of self or others.

Skills

• Knowledge of federal and state program policies and laws, financial and medical eligibility program policies, and quality control procedures.
• Skill in interviewing, analyzing data, and using a computer and applicable software.
• Ability to apply program and quality control policies and procedures.
• Ability to ensure compliance with state and federal regulations.
• Ability to select, analyze, and evaluate information from case records in relation to eligibility criteria.
• Ability to communicate effectively.