Quality Assurance Specialist III

About the role

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. 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 and 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 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. Performs other duties as assigned.

Essential Job Functions

• 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. Performs appropriate routing of intakes based on program type and expected time frames. (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. This process includes notifying regional staff of 24-hour priority or 2-day priority intakes. (20%)
• Performs quality assurance reviews for non-jurisdictional intakes (CI Tickets) to ensure the facility/agency is within Federal or State Jurisdiction. When found to be non-jurisdictional, the intake is referred to another applicable agency, 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 inquires, address issues or resolve problems. (5%)
• Provides complex professional and technical assistance/consults to others on policies, procedures, rules, regulation, 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%)

Qualifications

• Required either a Bachelor's or Associates 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.
• Applicant must be able to work Monday through Friday, 10:30 AM to 7:30 PM.
• Must be available to work holidays as needed.
• In basket will be given.
• Applicants must pass a fingerprint and criminal background check prior to employment.

Licensure Requirements

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.

Knowledge, Skills, and Abilities

• 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, with others orally and in writing to provide information.
• 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.

Schedule

Monday through Friday, 10:30 AM to 7:30 PM. Must be available to work holidays as needed.

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

$6,101.31 - $6,779.25 monthly

Telework

This position is full-time telework with travel to the office as business needs require. Telework employees are responsible for providing the required infrastructure for working from home. HHSC does not pay installation, monthly fees, or other charges for additional equipment, personal telephone lines (cellular or land lines), or high-speed internet access in an employee's residence. Telework employees will not be reimbursed for travel from the employee's residence to the office.

This response is AI-generated, for reference only.