POSITION SUMMARY

Supports quality improvement efforts and alignment with contractual requirements by conducting audits of staff, current processes, reports, and procedures to identify process improvements and issue resolutions. Identifies, develops, and conducts staff training based on outcomes of audits. Assist with development, implementation, support, and promotion of all Health Services programs, policies and procedures.

REQUIREMENTS FOR ALL POSITIONS

1. All employees shall meet Compliance/Privacy Regulations and attend at a minimum one (1) hour of Compliance/Privacy educational training annually, as required by Independent Living Systems.

2. All employees, if duly licensed in the State of employment, and said license is part of the requirement of their position with Independent Living Systems, shall maintain their license in good standing and keep it current throughout their employment.

3. All employees are required to maintain confidentiality, protect privacy, comply with PHI regulations, and report violations.

POSTITION RESPONSIBILITES AND ACCOUTABILITY

1. Provides ongoing and random qualitative and quantitative analysis of the business process, clinical systems, tools, and staff competencies using organizational performance measurements to ensure compliance with government regulations and corporate policy.

2. Reviews and evaluates internal controls to ensure ongoing compliance.

3. Identifies, documents, and reports any transaction errors in a timely manner to ensure prompt resolution.

4. Identifies, develops and oversees ongoing educational and support needs of care management staff.

5. Tracks and trends audit results, providing feedback to management.

6. Recommends corrective action and facilitates the implementation of remedial and process improvement plans.

7. Develops and conducts staff training based outcomes of clinical audits

8. Implements training programs to increase role specific consistencies and efficiencies related to process work flows.

9. Measures outcomes of staff training and identifies key findings to ensure effective alignment of training content and method of delivery with business objectives and staff performance requirements

10.Facilitates communication of relevant findings to corporate Compliance Department and/or Corporate Privacy/Security Officer.

11. Facilitates communication of relevant findings to corporate Compliance Department and/or Corporate Privacy/Security Officer.

12. Performs other duties as required.

13. Adheres to organizational policies and procedures.

14. Maintains a working knowledge of and adheres to applicable federal/state regulations including but not limited to, laws related to patient confidentiality, release of information, and HIPAA.

15. Maintains appropriate professional boundaries.

16. Uses safe work practices. Promptly addresses workplace and patient safety issues.

17. Interacts in a manner, which is professional, respectful, positive, helpful, and promotes trust.

18. Maintains professional growth and development.

POSITION QUALIFICATION

Minimum Education :

• Preferred RN License; LPN, LCSW, or Bachelors in a related field

Minimum Experience :

• 3-5 years’ experience in managed care (case management, utilization management, and/or behavioral health case management)

Other:

• Strong data analysis and report preparation skills.
• Ability to use standard software packages and applications such as MS Word, Excel, PowerPoint, etc.
• Excellent verbal and written communication skills
• Valid Drivers License