Quality Assurance Specialist III

Location: Pittsburg, TX

About the Role

Join the Texas Health and Human Services Commission (HHSC) and be part of a team committed to creating a positive impact in the lives of fellow Texans. At HHSC, your contributions matter, and we support you at each stage of your life and work journey. Our comprehensive benefits package includes 100% paid employee health insurance for full-time eligible employees, a defined benefit pension plan, generous time off benefits, and numerous opportunities for career advancement.

This position serves as a Quality Assurance Monitoring Specialist with the Quality Assurance Unit. Quality Reviews include Long Term Care and Home and Community Support Services Agency (HCSSA) complaints and self-reported incidents. The schedule is Monday through Friday, 10:30 AM to 7:30 PM.

Responsibilities

• Reviews daily intakes of all allegations of abuse, neglect, and exploitation received by intake specialists to determine if it is a violation and to ensure timely and accurate triage and prioritization.
• Edits reports prepared by intake specialists prior to sending electronically to the regional offices for investigation to ensure quality control and accountability standards are maintained.
• Analyzes and interprets Regulatory Services policies, procedures, and regulations.
• Provides consultation to agency staff, providers, advocates, consumers, legislators, and other agencies.
• Serves as a liaison between the Complaint Intake Unit and regional field operations staff.
• Assists with the intake of complaints, incidents, and requests for information.
• Performs quality assurance reviews of long-term care and non-long-term care complaints, incidents, and addendums to ensure accuracy/compliance with applicable Federal and State regulations (35%).
• Evaluates long-term care and non-long-term care complaints and incidents related to abuse/neglect/exploitation of children, elderly, individuals with mental illness, or individuals with intellectual disabilities to ensure the assigned priority is in alignment with Federal and/or State regulations (20%).
• Performs quality assurance reviews to ensure appropriate triage of priority, facility patient history, allegations, grammar, punctuation, spelling, and conditions of participation/coverage (20%).
• Performs quality assurance reviews for non-jurisdictional intakes (CI Tickets) to ensure the facility/agency is within Federal or State jurisdiction. Refers non-jurisdictional intakes to applicable agencies such as the Ombudsman, the Joint Commission, or the Medical Board (10%).
• Communicates on a complex level with others (internally or externally) to provide, exchange, or verify information; answer inquiries, address issues, or resolve problems (5%).
• Provides complex professional and technical assistance/consults to others on policies, procedures, rules, regulations, standards, or requirements (5%).
• Maintains current knowledge in assigned areas by reviewing literature, attending meetings/seminars/work groups/trainings, or communicating with other professionals (5%).
• Performs related work and may participate in special projects and workgroups as assigned.
• Interprets policies, procedures, rules, regulations, and standards and communicates on a complex level with others to exchange or verify information, respond to inquiries, address issues, or resolve problems.

Requirements

• Required either a Bachelor's or Associate's degree from an accredited college or university or Nursing Licensure (RN/LVN) from a university or nursing program.
• Experience in Long Term Care Program, HCSSA Program, or Acute Care Program preferred.
• Must be available to work Monday through Friday, 10:30 AM to 7:30 PM.
• Must pass a fingerprint and criminal background check prior to employment.
• Must be available to work holidays as needed.
• Applicants must be able to provide the required infrastructure for working from home, including high-speed internet access.

Qualifications

Any one of the following Registrations, License Requirements, or Certifications are required:

• Licensed Vocational Nurse (LVN) or Registered Nurse (RN)
• SMQT
• QIDP
• Medical Technologist/Laboratory Technician
• Surgical Assistant
• Emergency Medical Technician
• End Stage Renal Disease/Dialysis Technician
• Other License/Degree/Certification in Health Care

Skills

• Knowledge of state and federal laws and regulations related to regulatory programs.
• Knowledge of health care principles, practices, and procedures.
• Ability to effectively communicate, organize, and present information orally and in writing.
• Ability to present professional and knowledgeable information to internal and external stakeholders.
• Ability to use judgment, make effective decisions, and prioritize work.
• Ability to analyze and solve problems.

Benefits

• 100% paid employee health insurance for full-time eligible employees.
• Defined benefit pension plan.
• Generous time off benefits.
• Numerous opportunities for career advancement.

Pay

Salary Range: $6,101.31 - $6,779.25 per month

Schedule

• Full-time, regular position.
• Monday through Friday, 10:30 AM to 7:30 PM.
• Eligible for telework with up to 5% travel.
• Regular evening and weekend shifts may be required.