Quality Assurance Risk Management Coordinator

About the role

Step into a role where your careful thinking can spark real progress! As a Quality Assurance Risk Management Coordinator for the Department of Human Services, you will evaluate programs and help improve the quality of behavioral health services. You will work with partners who share a commitment to strong, reliable care. Your contributions will lead to better results for communities across the state.

Responsibilities

• Program Reviews: Examine contractor and managed care operations for compliance with federal and state rules
• Data Evaluation: Assess documents and reports to determine if standards, goals, and benchmarks are met
• Compliance Monitoring: Review service decisions and related documentation for clarity and adherence to medical necessity requirements
• Onsite Audits: Lead audits and interviews to evaluate access, quality, and risk in behavioral health services
• Collaboration Efforts: Work with internal and external partners on quality reviews and clinical best practices
• Policy Analysis: Study legislative and regulatory changes and interpret their impact on behavioral health services

Qualifications

• One year as a Quality Assurance/Risk Management Specialist (Commonwealth job title or equivalent Federal Government job title, as determined by the Office of Administration);
• Three 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;
• Three years of clinical experience in a human services agency, including two years of administrative, evaluative, consultative or supervisory work 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;
• Any equivalent combination of experience and training.

• Other Requirements: You must meet the PA residency requirement. For more information on ways to meet PA residency requirements, follow the link and click on Res