Quality Assurance and Improvement Specialist

Status: Full Time, Non-Exempt Starting Wage: $26.32/hr. Position Open Until Filled Please submit a Resume with the application *Monday - Friday 8:00am to 4:30pm*

Dodge County offers a generous benefits package including:

• Paid Time Off (PTO) - available for use after 30 days of employment
• 10 observed paid holidays
• Health, Dental, Vision Insurance
• Health Savings Account (HSA) - with employer contributions - HRA
• Life insurance, Long-term disability, Short-term disability and Flex spending
• Participation in the Wisconsin Retirement System (WRS) - an exceptional pension plan with employer match (upon vesting) and lifetime retirement payment.

ESSENTIAL FUNCTIONS

1. Maintains knowledge of Federal and State rules, regulations and Administrative Codes that impact Medicaid; trains staff to recognize and correct errors and ensure program compliance and accuracy.
2. Performs Quality Assurance reviews on internal cases and contracted provider records for compliance with Federal and State statutes, Department policies and procedures, and Administrative Codes. Analyzes the results of reviews and works with Department staff on implementing corrective measures. Develops QA tools and reports to ensure compliance with program policy and procedures, Medicaid/Medicare requirements and State statutes.
3. Assists with onsite and desk review program evaluations and state recertification visits; coordinates with the unit supervisor to create and implement plans of correction when necessary.
4. Develops and maintains resources and training materials for use with internal staff and contracted partners; attends trainings to maintain current knowledge of all rules and regulations enacted by Federal, State and local entities relative to Medicaid/Medicare requirements.
5. Provides onboarding, training, and ongoing support to contracted CCS providers to maintain statutory compliance. Ensures initial and annual training requirements are met as outlined in State statutes.
6. Identifies and assists in developing Quality Improvement strategies for Department programs, and monitors results of implementation of those strategies. Ensures that a continuous improvement cycle process is maintained.
7. Assists in monitoring quality of providers through quality improvement functions, contract performance standards, outcome measures, and consumer and department staff feedback.
8. Annually administers client satisfaction surveys and compiles results.
9. Facilitates meetings with leadership and staff on the analysis of performance, including identification of challenges, achievement, and compliance with established guidelines and best practice standards.
10. Participates actively and effectively in activities such as conference calls and professional meetings to include fiscal-related Statewide and Regional meetings.
11. Completes and maintains necessary documentation and reports according to applicable audit and statutory requirements, Codes, and policies.
12. May be designated to speak to the community and other organizations to provide public education.
13. Maintains regular and predictable attendance.
14. Other duties as assigned.

REQUIRED JOB COMPETENCIES

• Knowledge of laws and regulations that affect the delivery of services provided by the Department.
• Knowledge of applicable State statutes.
• Knowledge, understanding, and ability to interpret CMS billing requirements.
• Working knowledge of mental health and AODA diagnoses and treatment.
• Working knowledge of client rights, confidentiality, standards of practice, and ethics in mental health/AODA field.
• Working knowledge of applicable Wisconsin State Administrative Codes, including but not limited to, Chapters 34, 35, 36, 48, 51, 55, 63, 75, 92, and 94; and Medicaid Waiver Manual (CLTS).
• Knowledge of legal requirements including privacy, resident rights, confidentiality, and non-discrimination.
• Knowledge of goals, principles, and practices of human service programs, program administration, and program goals and their intended impacts.
• Knowledge of the County and Department's operating requirements, policies, procedures, and practices; and local, State, and Federal regulations related to department programs and operations.
• Skill in analyzing complex administrative information and issues, defining problems and evaluating alternatives, and recommending methods, procedures and techniques for resolution of issues.
• Ability to research and analyze detailed information and make appropriate recommendations.
• Ability to develop, interpret and implement regulations, policies, procedures, written instructions, general correspondence, and other department-specific documents.
• Ability to adapt and take control of situations, dictating subordinate activities in a responsible manner.
• Ability to establish and maintain accurate records of assigned activities and operations.
• Ability to interpret and implement local policies and procedures; written instructions, general correspondence; Federal, State, and local regulations.
• Skill in organizational and time management to prioritize duties to accomplish a high volume of work product while adapting to constant changes in priority.
• Ability to perform detailed work accurately and independently in compliance with stringent time limits requiring minimal direction and supervision.
• Ability to think quickly, maintain self-control, and adapt to stressful situations.
• Knowledge of current office practices and procedures and knowledge of the operation of standard office equipment and software.
• Knowledge of computer software including word processing, spreadsheet, and database applications consistent for this position.
• Ability to perform mathematical calculations required of this position.
• Ability to communicate clearly, concisely, and effectively in English in both written and verbal form.
• Skill in researching and understanding complex written materials.
• Ability to prepare and maintain accurate and concise records and reports.
• Ability to apply sound judgment and discretion in performing duties, resolving problems, and interpreting policies and regulations.
• Ability to communicate detailed and often sensitive information effectively and concisely, both orally and in writing.
• Ability to handle sensitive interpersonal situations calmly and tactfully.
• Ability to maintain professionalism at all times.
• Ability to maintain effective working relationships with individuals within and outside the organization.
• Ability to maintain confidentiality and discretion regarding business-related files, reports, and conversations, within the provisions of open records laws and other applicable State and Federal statutes and regulations.
• Ability to work the allocated hours of the position and respond after hours as needed.

PHYSICAL AND WORK ENVIRONMENT

• This work requires the occasional exertion of up to 25 pounds of force; work regularly requires sitting, frequently requires standing, speaking or hearing, using hands to finger, handle or feel and repetitive motions and occasionally requires walking, stooping, kneeling, crouching or crawling and reaching with hands and arms.
• Work has standard vision requirements.
• Vocal communication is required for expressing or exchanging ideas by means of the spoken word.
• Hearing is required to perceive information at normal spoken word levels.
• Work requires preparing and analyzing written or computer data and observing general surroundings and activities.
• Frequent travel may involve exposure to inclement weather conditions, unsanitary conditions in homes, communicable illnesses and diseases and unsafe environments.
• Work is performed in an office setting.

Dodge County is an Equal Opportunity Employer. Qualified applicants will receive consideration without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

If you are a job seeker with a disability and require a reasonable accommodation to apply for one of our jobs, you will find the contact information to request the appropriate accommodation by visiting the following page: Accessibility Accommodation for Applicants

Bachelors (required)

Experience working in an Electronic Health Record (EHR). (preferred)
Experience working in/with state certified programs and state and federal privacy guidelines and statutes. (preferred)
Previous work experience with Compliance or Quality Assurance in a Human Services environment. (preferred)
Bachelor's degree in social work, business administration, public administration, or Human Services related field. Master's degree preferred. (required)
Must successfully pass caregiver and criminal background check. (required)
Must possess a valid driver's license. (required)