Under the general supervision of the Director of Crisis Quality and Compliance, the Quality & Compliance Specialist is responsible for evaluating and monitoring the quality of care for Crisis Care Services.
Key responsibilities
- Ensure compliance with all applicable state and federal requirements while promoting safety, quality, and effective service delivery.
- Oversee data collection, monitoring, analysis, and reporting systems in compliance with PIHP and state requirements.
- Interpret, formulate, and maintain continuous quality improvement and quality assurance programs.
- Perform quality assurance reviews to ensure services align with national standards, compliance requirements, and state regulations.
- Create performance improvement projects based on quality analysis.
- Prepare quality documentation and reports by collecting, analyzing, and summarizing information and trends.
- Review quality outputs for internal and external compliance.
- Ensure clinic policies meet PIHP, state, federal, Joint Commission, and other accreditation standards.
- Review agency and state policies for consistency in implementation.
- Prepare recurring reports based on organizational and certification-related requirements.
- Recommend changes to organizational policies and procedures.
- Work with department supervisors to identify quality objectives and system issues, then monitor approved changes.
- Conduct internal investigations, gather and analyze data, interview stakeholders, and recommend corrective actions.
- Complete incident reports, critical and sentinel event reporting, root cause analysis, and improvement plans as needed.
- Prepare the clinic and programs for accreditation reviews, including Joint Commission site reviews.
- Draft written reports and presentations related to evaluation processes and findings.
- Present performance and evaluation data to leadership and care teams on a monthly or quarterly basis.
- Develop and train staff on protocols, procedures, policies, and compliance standards.
- Work cross-functionally to define analysis plans, ensure data quality, and produce actionable results.
- Use systematic methods to collect and analyze data and identify gaps and strengths.
Requirements & Qualifications
Education
- Bachelor’s degree from an accredited college or university in Human Services, Social Services, Nursing, Public Health, Public Administration, Healthcare Administration, Health Management, Epidemiology, or a related field.
- Master’s degree in one of the listed fields is preferred.
Experience
- Four years of professional experience in a behavioral healthcare or mental health setting.
- Two years of professional experience in quality management and accreditation.
- Experience with statistical analysis of healthcare data, metrics, systems, and standards.
Knowledge and skills
- Knowledge of quality improvement principles, quality assurance, accreditation and certification standards, compliance standards, and healthcare law/regulations.
- Knowledge of behavioral health practices and terminology.
- Knowledge of Medicaid screening processes and MDHHS policies, rules, regulations, and procedures.
- Knowledge of fraud and abuse laws, including the False Claims Act, Stark Laws, and the Anti-Kickback Statute.
- Knowledge of HIPAA compliance.
- Strong analytical, critical thinking, report writing, communication, project management, and organizational skills.
- Ability to work effectively with diverse populations.
Certifications and license
- Valid State of Michigan Driver’s License with a safe and acceptable driving record.
- Certified Professional in Healthcare Quality certification preferred.
Location
Detroit, Michigan, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
4 weeks ago