Quality Assurance Compliance Specialist- Program Specialist Senior

This is an internal job posting. Only former Multnomah County employees on an active recall list may apply.

About the Role

This position is in the Quality Management (QM) and Compliance Program of the Behavioral Health Division. The QM/Compliance Program focuses on quality assurance and quality improvement processes, measurement of performance and quality indicators, and monitoring of compliance standards for contracted providers and county behavioral health (BH) services. This position supports contracts and budget reviews for programs as well as policies and procedures.

Responsibilities

• General Compliance Oversight; Regulatory, Policy and Legislative
  • Provide subject matter expertise on compliance and regulatory requirements for BHD Safety Net Services programs to drive initiatives, support programs in improving outcomes or services, and implement requirements.
  • Conduct workflow analysis to identify areas for improvement, simplify redundant processes, and address quality assurance/compliance requirements.
  • Identify problems and formulate solutions independently or through consensus with Oregon Health Authority (OHA) and BHD.
  • Identify trends and issues presenting in multiple systems and facilitate communication/meetings regarding systems issues (including with OHA and County Systems).
  • Formulate corrective action strategies as needed.
  • Collect and analyze information concerning the implementation of policy decisions, and analyze the effect of policy decisions upon service delivery and operations.
  • Monitor program compliance with Oregon Administrative Rules (OARs) regarding provision of services, standards of care, and patient safety.
  • Collaborate with Safety Net Services Leadership and staff on planning and coordinating ongoing training.
  • Provide technical assistance when needed/requested by the Safety Net Services Unit.
  • Participate in Rule Advisory Committee meetings and provide engagement with rule changes, including in-person meetings, written feedback and comments, and communication back to the team about how rule changes may impact work/workload.
  • Annually, during the legislative session, monitor legislation having an impact on programs; prepare policy statements on legislative topics.
  • Provide Senior Management analysis and assessment of how legislation will impact compliance-related activities for programs in the Division.
• Risk Assessments and Audits
  • Conduct Risk Assessments and internal Audits of BHD programs when issues arise, or on a predetermined schedule per Compliance Plan.
  • Develop, implement, and maintain BHD Compliance Plan, quality management plans, and systems to ensure compliance and achieve program outcomes.
  • Develop and administer sophisticated survey instruments to evaluate program effectiveness and recommend proposals based on data-driven analysis.
  • Develop program evaluation criteria; collect data to evaluate program performance based on rules, regulations, guidelines, goals, and objectives; analyze and prepare formal assessments and reports of BHD programs; make program recommendations based on research and analysis conducted.
  • Issue Corrective Action Plans as indicated. Monitor compliance with any recommendations or Corrective Action Plans.
  • Work with other members of the Quality Management team to provide technical assistance to programs negotiating Corrective Action plans.
• Investigations
  • Conduct investigations of code of conduct, fraud, waste, and abuse allegations.
  • Review mental health treatment records, operational records, and conduct interviews.
  • Compile and analyze all investigative findings in order to reach a conclusion regarding allegations.
  • Write detailed investigative reports summarizing findings and supporting conclusions and recommendations for corrective action.
  • Work with the County Attorney’s office, Human Resources, the Protected Class Complaint office, leadership, and the Quality Management team to evaluate reports of misconduct, fraud, waste, or abuse allegations to determine the appropriate course of action and role delineation.
• External Audits
  • Participate in Behavioral Health and provider network regional compliance audits and quality assurance reviews.
  • Work as a team member with the rest of the Quality Management team to compile operational documents, policies, and client files for submission for audits of BHD.
• Contract and Boilerplate Maintenance
  • Review program quality control activities over complex contracts with high levels of funding at risk.
  • Conduct analysis on contract best practices and trends and formulate recommendations.
  • Advise senior management on policy and organizational issues with the contract process and make recommendations for process improvement.
  • Identify problems and formulate solutions independently or through consensus with stakeholders; provide project management on inter-divisional contract projects.
  • Consult with programs in BHD to assist with their development and implementation of training for revised or new business systems or processes.

Requirements

• Minimum Qualifications
  • Education/Training: Equivalent to a bachelor's degree and three (3) to six (6) years of experience that demonstrates the ability to perform the duties of the position. (Equivalency: 7-10 years of qualifying training and/or experience).
  • Ability to complete Healthcare Basic Compliance Academy within the 1st year in the position (Health Care Compliance Association).
  • Working knowledge of contract compliance criteria and quality indicators.
  • Experience in conducting audits or investigations, including data collection, analysis, recommendations for corrective action, and compliance monitoring.
  • Experience with Medicaid billing, managed care systems, and/or health plans.
• Preferred Qualifications/Transferable Skills
  • Certified in Healthcare Compliance (CHC).
  • Subject matter expert in quality assurance.
  • Knowledge of issues faced by those who experience behavioral health challenges and a basic understanding of the full continuum of care for those in need of services.
  • Lead with race through actions and advocacy with internal programs, with community partners, and across departments throughout the county.
  • Demonstrate the ability to flex style in order to be effective across cultural contexts. Respect and appreciation for ethnic and cultural diversity.
  • Ability to collaborate and build relationships to achieve positive work outcomes.
  • Ability to maintain a safe and healthy workplace.
  • High degree of resilience, is outcome-driven, and can thrive in an environment of rapid change while managing pressure in an effective and professional manner.

Benefits

Multnomah County offers an exceptional benefits package, including:

• Employer-funded retirement savings.
• Health and dental insurance at very low cost to full-time employees and their dependents.
• Paid parental leave.
• Wellness programs.
• A focus on work-life balance.

Pay

$45.27 - $55.67 hourly.

Schedule

• This hourly union-represented position is eligible for overtime.
• Type: Represented, FLSA: Non-Exempt.
• At this time, this position is designated to “routine telework,” meaning you will be working remotely (from home) most of the time; a hybrid schedule also is available. Employees may be required to come into the office on occasion. Currently, all employees must reside in Oregon or Washington.