Compliance and Outcomes Manager

at  Horizon Services Inc

FUNCTIONAL/TECHNICAL SKILLS & KNOWLEDGE:

(knowledge and skills required to effectively perform the job)

• Interpersonal communication
• Motivating others
• Written communication
• Honesty/integrity
• Problem Solving
• Developing others
• Vision/planning
• Creativity/innovation
• Conflict resolution
• Delegation
• Valuing Diversity
• Ability to problem solve quickly.
• Ability to interface with community members, CBO’s Funders and all referral sources in a positive manner.
• Ability to balance the leadership needed to move forward and the compassion to facilitate the needs of a counseling staff.
• Ability to recognize stress factors in a crisis environment and find creative inexpensive ways to reduce them.
• Ability to control emotions in situations of conflict.
• Ability to handle multiple projects at one time.
• Ability to process and develop appropriate conclusions.
• Needs to be able to work in stressful situations where information is needed in a short period of time.
• Knowledge of best clinical practices
• Microsoft Office, including word PowerPoint, Excel.

What else is required?

• BA degree or equivalent training/experience as described below.
• 2 + years of substance use disorder, mental health, or similar Quality Assurance and Compliance
• Preferred, SUD or mental health certification with state certifying organization or professional board.

Quality Assurance/Quality Improvement (QAQI)

• Under direction of Compliance and Outcomes Administrator, the Compliance and Outcomes Manager coordinates, implements, and oversees the Quality Assurance and Quality Improvement (QAQI) functions for the assigned program(s) or line(s) of service.
• Provide day-to-day implementation and management of QAQI functions for assigned program(s), including but not limited to conducting clinical documentation audits, routine patient chart reviews, environment of care quality monitoring and improvement assessments, and coordination with stakeholder QAQI department authorities.
• Provides monthly QAQI reports to Compliance and Outcomes Administrator for assigned program(s). Reports include review and identification of potential deficiencies within clinical documentation and patient charts, environment of care quality, and outcome data quality.
• Coordinates with Program Managers to ensure effective implementation and monitoring of QAQI functions at assigned program(s).
• Coordinates and facilitates QAQI inspections, chart reviews, CQRT meetings, and reporting to oversight agencies and participates in external auditing processes for assigned program(s). Develops audit response documentation, including corrective action plans (CAPs) and performance improvement plans (PIPs) and submits to Compliance and Outcomes Administrator for approval before submission. Performs timely completion and documentation of corrective actions and implements mechanisms to avoid repetition of negative audit findings.
• Assists Compliance and Outcomes Administrator to develop and implement policies, procedures, tools, protocols, and QAQI calendars to enhance productivity, performance, and efficiency related to QAQI functions.
• Serves as primary point of contact for oversight agencies for assigned program(s) and manages stakeholder communications related to QAQI functions under direction of Compliance and Outcomes Administrator. Regularly attends QAQI meetings with funders and external stakeholders and communicates any updates or changes to staff at assigned program(s). Summarizes and relays this information to Administrator.
• Coordinates with Program Manager for assigned program(s) to recommend improvements and corrective actions to be implemented at the assigned program(s).

Measuring Outcomes & Data Management

• Gather and manage program data used to enhance service delivery, QAQI functions, strategic planning, regulatory compliance, client outcomes, and client satisfaction. Coordinates with IS Department as these processes relate to electronic systems.
• Analyzes and summarizes gathered data for assigned program(s) and reports to Compliance and Outcomes Administrator and assists in development of improvement recommendations to agency leadership.
• Generates QAQI, outcomes, and program compliance reports and deliverables for Compliance and Outcomes Administrator to compile and report to agency leadership. Ensures data integrity and availability for assigned program(s).

• Assist with development of procedures to collect regular feedback from clients, staff, and other stakeholders. Implement feedback mechanisms for assigned program(s) and report to Compliance and Outcomes Administrator.Serve as designated Privacy Officer for assigned program(s) and monitor compliance with all data security and privacy standards as defined by HIPAA, 42 CFR, and related County, State, and Federal privacy rules. Respond to requests for records and address any privacy/security related grievances or complaints under direction from Compliance and Outcomes Administrator.

Program & Licensing Compliance

• Under direction of Compliance and Outcomes Administrator, develops, coordinates, implements, and monitors the maintenance of program licensing compliance functions for assigned programs.
• For assigned program(s), monitor and maintain all documentation pertaining to staff certification and licensing, TB testing and health screening, CPR and First Aid Certification, staff identification, insurance, and all other credentialing and personnel file requirements as defined by DHCS, DMC-ODS, BBS, SUD counselor certification bodies, and other regulatory oversight agencies and stakeholders. Provide copies of credentialing documents to Human Resources. Coordinates with Program Managers on corrective actions related to personnel credentialing and record maintenance.
• Reports program licensing compliance deficiencies identified through routine monitoring of program operations and documentation to Administrator on a monthly basis and coordinates with Program Manager(s) for assigned programs to ensure timely correction and resolution of deficiencies prior to audit.
• Coordinates DHCS licensing inspections and facilitates external auditing processes. Develops written responses to audit reports, including corrective action plans (CAPs) and performance improvement plans (PIPs). Ensures timely completion and documentation of corrective actions and implements mechanisms to avoid repetition of negative audit findings.
• Assist Compliance and Outcomes Administrator in development of policies, procedures, tools, calendars, and protocols to enhance licensing compliance operations for assigned programs.
• Under direction of Compliance and Outcomes Administrator, coordinate with Program Managers to support their communications with DHCS and other licensing bodies regarding licensure applications and any other formal communications for assigned programs.
• Conduct routine, unannounced internal audits, including chart reviews, for program licensing compliance and communicate any findings to Administrator and Program Managers in order to coordinate prompt resolution to identified deficiencies.
• Participate in weekly meetings with Compliance and Outcomes Managers and Administrator to coordinate program and licensing compliance efforts across the organization, develop improved monitoring practices, and receive regular feedback related to ongoing compliance issues.
• Maintain expert knowledge regarding program licensing compliance standards as defined by DHCS and other licensing agencies when applicable. Coordinate with Compliance and Outcomes Department to educate staff and ensure program operations remain consistent with current standards. Assist in the planning, coordination, and facilitation of organizational trainings or other communications needed to ensure ongoing licensure compliance.

Operational DMC-ODS Compliance

• Under direction of Compliance and Outcomes Administrator, develops, coordinates, implements, and monitors the maintenance of DMC-ODS compliance functions for assigned programs.
• Reports DMC-ODS compliance deficiencies identified through routine monitoring of program operations and documentation to Administrator on a monthly basis. Coordinates with Program Manager(s) for assigned programs to ensure timely correction and resolution of deficiencies prior to audit.
• Coordinates DMC-ODS inspections and facilitates external auditing processes. Develops written responses to audit reports, including corrective action plans (CAPs) and performance improvement plans (PIPs). Ensures timely completion and documentation of corrective actions and implements mechanisms to avoid repetition of negative audit findings.
• Assist Compliance and Outcomes Administrator in development of policies, procedures, tools, calendars, and protocols to enhance DMC-ODS compliance operations for assigned programs.
• Under direction of Compliance and Outcomes Administrator, coordinate with Program Managers to support their communications with DMC-ODS Provider Enrollment regarding DMC-ODS applications and any other formal communications for assigned programs.
• Conduct routine, unannounced internal audits, including chart reviews, for DMC-ODS compliance and communicate any findings to Administrator and Program Managers in order to coordinate prompt resolution to identified deficiencies.
• Monitor and track clinical documentation for timeliness, accuracy, and completion, including medical necessity, medical clearance, clinical assessment, treatment plans, progress notes, etc. Provide prompt notifications and reminders to clinical staff regarding upcoming documentation deadlines.
• Participate in weekly meetings with Compliance and Outcomes Managers and Administrator to coordinate DMC-ODS compliance efforts across the organization, develop improved monitoring practices, and receive regular feedback related to ongoing compliance issues.
• Maintain expert knowledge regarding DMC-ODS compliance standards as defined by DHCS and other licensing agencies when applicable. Coordinate with Compliance and Outcomes Department to educate staff and ensure program operations remain consistent with current standards. Assist in the planning, coordination, and facilitation of organizational trainings or other communications needed to ensure ongoing DMC-ODS compliance.

Contract Compliance

• Under direction of Compliance and Outcomes Administrator, develops, coordinates, implements, and monitors the maintenance of contract compliance functions for assigned programs.
• Reports contract compliance deficiencies identified through routine monitoring of program operations and documentation to Administrator on a monthly basis. Coordinates with Program Manager(s) for assigned programs to ensure timely correction and resolution of deficiencies prior to audit.
• Coordinates contract inspections and facilitates external auditing processes. Develops written responses to audit reports, including corrective action plans (CAPs) and performance improvement plans (PIPs). Ensures timely completion and documentation of corrective actions and implements mechanisms to avoid repetition of negative audit findings.
• Assist Compliance and Outcomes Administrator in development of policies, procedures, tools, calendars, and protocols to enhance contract compliance operations for assigned programs.
• Under direction of Compliance and Outcomes Administrator, coordinate with Program Managers to support their communications with contract agencies to maintain strong stakeholder relationships and address updates to contract requirements/deliverables for assigned programs.
• Conduct routine, unannounced internal audits, including chart reviews, for contract compliance and communicate any findings to Administrator and Program Managers in order to coordinate prompt resolution to identified deficiencies.
• Participate in weekly meetings with Compliance and Outcomes Managers and Administrator to coordinate contract compliance efforts across the organization, develop improved monitoring practices, and receive regular feedback related to ongoing compliance issues.
• Maintain expert knowledge regarding contract compliance standards as defined by contracting agencies. Coordinate with Compliance and Outcomes Department to educate staff and ensure program operations remain consistent with current standards. Assist in the planning, coordination, and facilitation of organizational trainings or other communications needed to ensure ongoing contract compliance.

Utilization Management

• Gather, monitor, and manage collection of utilization management (UM) data for assigned program(s). Report UM data and make recommendations to Compliance and Outcomes Administrator and Program Managers to ensure census goals are met and maintained for assigned program(s). Address and resolve UM data integrity and management issues as needed.
• Implement, monitor, and make corrective actions as needed to track individual client service authorizations and provide regular notifications to program staff to support timely authorization renewal to avoid lapse in services for assigned program clientele.
• Responsible for collecting, organizing, and reporting program census data, reconciliation of services with billing entries in electronic systems, and other program UM, census, revenue, or service-related data. Data reported to Finance Department is timely and accurate.

SUCCESS COMPETENCIES FOR POSITION (competencies required to effectively perform the job)