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Senior Compliance and Quality Specialist- Audit
- CDS Life Transitions (Webster, NY)
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Summary:
The Senior Compliance and Quality Specialist is responsible for coordinating and monitoring PCC’s internal audit and validation processes. This role provides direct supervision to assigned staff per organizational structure.
Essential Job Functions
+ Assist with drafting and maintaining policies, procedures, and standard operating procedures related to compliance and quality.
+ Coordinate, assign and manage audit schedules.
+ Provide support, training, direction and supervision to the audit staff.
+ Conduct and document internal audits and other quality improvement activities.
+ Assist with monitoring risk management activities, compliance, and quality work plans.
+ Assist with developing, maintaining, and distributing reports on compliance and quality to include audit findings, analysis of trends, patterns, and potential quality improvement opportunities.
+ Assist with devising sampling procedures and directions for recording and reporting quality data.
+ Assist with the development, audit, and reporting of the Quality Management Program and all of its components.
+ Develop audit tools to include regulatory and quality components.
+ Assist with investigating complaints and non-conformance issues.
+ Assist with supporting on-site audits conducted by external providers.
+ Assist with collecting, compiling, and analyzing statistical quality data to identify areas for improvement in the quality system.
+ Support in developing, recommending and monitoring corrective and preventive actions.
+ Identify training needs and organize training interventions to meet quality standards.
+ Interpret and implement quality improvement standards and procedures.
+ Assist with evaluating adequacy of quality improvement standards.
+ Assist in monitoring compliance with all federal/state laws and regulations,
+ Participate on committees and work groups as assigned.
+ Perform any other related duties as required by supervisor.
Knowledge, Skills, and Abilities
+ Knowledge of OPWDD and/or DOH regulations, programs, and service delivery systems including Medicaid Service Coordination, Care Coordination, Managed Care, Health Home Care Management and/or services for people with intellectual and developmental disabilities.
+ Must be able establish priorities and meet deadlines.
+ Must demonstrate attention to detail, planning and organizational skills.
+ Ability to work in a collaborative environment, work independently, and motivate others.
+ Ability to communicate effectively, both orally and in writing.
+ Ability to assess and act appropriately in crisis situations.
+ Proficient with technology and understanding of electronic health records.
+ Data collection, management and analysis skills required.
+ Maintain appropriate confidentiality and discretion at all times.
Education and Experience:
+ Bachelor’s Degree in Healthcare, Business, Human Services Administration, or related field.
+ Minimum 2 years of experience within a health care or human services setting.
+ Possession of valid, unrestricted NYS driver’s license required
All experience and education requirements, except when required by federal, state, or local laws or requirements, may be waived at the discretion of management with the approval of the Executive Director, in collaboration with Human Resources.
Physical Requirements/Working Conditions:
+ Ability to sit continuously.
+ Ability to reach above shoulder level.
+ Ability to turn/twist upper body.
+ Ability to use hand for repetitive action and fine manipulating for the purpose of keyboarding.
+ Must be able to travel throughout covered territories in Upstate NY as needed.
* Reasonable accommodations may be made to the extent required under applicable law to enable individuals with disabilities to perform the essential functions of this position.
Corporate Qualifications/Expectations:
+ Adhere to all Prime Care Coordination policies and procedures.
+ Adhere to the Agency Mission, Vision, Shared Values, and Customer Service Standards.
+ Attend mandatory education and training modules as scheduled; obtain and maintain required certifications/training by State regulations and PCC policy.
+ Act as a professional representative of PCC in regard to appearance, behavior, temperament, communication, language, and dress.
The statements herein are intended to describe the general nature and level of work being performed, but are not to be seen as a complete list of responsibilities, duties, skills, required of personnel so classified. Also, they do not establish a contract for employment and are subject to change at the direction of the employer.
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