Quality Assurance Risk Management Coordinator

Commonwealth of Pennsylvania; Pennsylvania; Hybrid; USD 60,000 - 80,000; Full time

Job summary

The Commonwealth of Pennsylvania in Harrisburg is seeking a Quality Assurance Risk Management Coordinator within the Department of Human Services to evaluate programs and improve the quality of behavioral health services. You will collaborate with partners to ensure strong, reliable care and better outcomes for communities statewide.

Primary duties include reviewing contractor and managed care operations for compliance with federal and state rules, evaluating performance data, and leading audits

Qualifications

• One year as a Quality Assurance/Risk Management Specialist or three years in a health care setting with a bachelor's degree.
• Experience evaluating programs, data, and compliance in behavioral health.
• Ability to analyze policy changes and their impact on services.

Responsibilities

• Program Reviews: Examine contractor and managed care operations for compliance with rules.
• Data Evaluation: Assess documents to ensure standards and benchmarks are met.
• Compliance Monitoring: Review service decisions for medical necessity and clarity.
• Onsite Audits: Lead audits to evaluate access, quality, and risk in behavioral health.
• Collaboration: Work with partners on quality reviews and clinical practices.
• Policy Analysis: Interpret legislative/regulatory changes for impact on services.

Skills

Quality Assurance

Risk Management

Program Evaluation

Data Analysis

Policy Analysis

Education

Bachelor's degree

Job description

THE POSITION

Step into a role where your careful thinking can spark real progress! As a Quality Assurance Risk Management Coordinator for the Department of Human Services, you will evaluate programs and help improve the quality of behavioral health services. You will work with partners who share a commitment to strong, reliable care. Your contributions will lead to better results for communities across the state.

Step into a role where your careful thinking can spark real progress! As a Quality Assurance Risk Management Coordinator for the Department of Human Services, you will evaluate programs and help improve the quality of behavioral health services. You will work with partners who share a commitment to strong, reliable care. Your contributions will lead to better results for communities across the state.

DESCRIPTION OF WORK

This position supports the improvement of behavioral health services by reviewing information, evaluating program performance, and working with partners across the Commonwealth. As a Quality Assurance Risk Management Coordinator, you will perform the following duties:

• Program Reviews: Examine contractor and managed care operations for compliance with federal and state rules
• Data Evaluation: Assess documents and reports to determine if standards, goals, and benchmarks are met
• Compliance Monitoring: Review service decisions and related documentation for clarity and adherence to medical necessity requirements
• Onsite Audits: Lead audits and interviews to evaluate access, quality, and risk in behavioral health services
• Collaboration Efforts: Work with internal and external partners on quality reviews and clinical best practices
• Policy Analysis: Study legislative and regulatory changes and interpret their impact on behavioral health services

Interested in learning more? Additional details regarding this position can be found in the position description.

Work Schedule and Additional Information

• Full-time employment
• Work hours are 8:00 AM to 4:30 PM, Monday - Friday, with a 60-minute lunch.
• Telework: You may have the opportunity to work from home (telework) part-time, up to 3 days per week. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Harrisburg. The ability to telework is subject to change at any time. Additional details may be provided during the interview.
• Salary:In some cases, the starting salary may be non-negotiable.
• You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices.

QUALIFICATIONS

REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY

Minimum Experience and Training Requirements

• One year as a Quality Assurance/Risk Management Specialist (Commonwealth job title or equivalent Federal Government job title, as determined by the Office of Administration); or
• Three years of professional experience as a member of a multiple disciplinary treatment team in a public or private health care facility and a bachelor's degree; or
• Three years of clinical experience in a human services agency, including two years of administrative, evaluative, consultative or supervisory work in a health care program; and a bachelor's degree with major course work in social work, nursing, health care administration, behavioral sciences or a related field; or
• Any equivalent combination of experience and training.

Other Requirements

• You must meet the PA residency requirement . For more information on ways to meet PA residency requirements, follow the link and click on Residency Guidelines.
• You must be able to perform essential job functions.

Veterans

• Pennsylvania law (51 Pa. C.S. 7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to www.pa.gov/agencies/employment/how-to-apply.html and click on Veterans.

Telecommunications Relay Service (TRS)

• 711 (hearing and speech disabilities or other individuals).

If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date.

The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply.

EXAMINATION INFORMATION

• Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam).
• Your score is based on the detailed information you provide on your application and in response to the supplemental questions.
• Your score is valid for this specific posting only.
• You must provide complete and accurate information or:
• your score may be lower than deserved.
• you may be disqualified.
• You may only apply/test once for this posting.
• Your results will be provided via email.