Quality & Compliance Manager - Outpatient Services

Colorado; Denver (CO); Hybrid; USD 90,000 - 120,000; Full time

Benefits offered by this job

Remote work arrangements

Flexible schedules

Career development

Job summary

Colorado Department of Human Services - Outpatient Services Division is seeking a Quality Assurance Auditor/Program Evaluation Lead to oversee credentialing, enrollment, audits, evaluation and continuous quality improvement for Civil and Forensic Mental Health programs. This role partners with CFH leadership and internal/external stakeholders.

The position emphasizes data-driven decision making, policy review, and guiding 20 FTE through coaching and performance planning in a hybrid work

Qualifications

• Seven years of behavioral/mental health leadership or related quality work.
• Experience with NCQA credentialing standards preferred.
• Knowledge of HIPAA and 42 CFR part 2 beneficial.

Responsibilities

• Lead OSDV Credentialing Committee and ensure NCQA alignment.
• Oversee payer enrollment processes for OSDV.
• Lead quality/compliance audits, evaluations, and analyses.
• Present data to leadership and stakeholders.
• Drive continuous quality improvement across divisions.
• Identify benchmarks and audit programs against standards.
• Mentor 20 FTE and contribute to performance planning.
• Collaborate to ensure regulatory and consent decree compliance.

Skills

NCQA standards experience

Payer enrollment

Quality audits

Data analysis

Program evaluation

Leadership coaching

Stakeholder communication

Job description

This position is open to current Colorado residents only.

Civil and Forensic Mental Health Services (CFMH) operates Colorado’s two mental health hospitals, the Forensic Services Division, the Division of Mental Health Transitional Living, and now the Outpatient Services Division. The office provides a continuum of mental health care for both Civil and Forensic clients. Civil clients are individuals who are committed by a civil court into the care of the Colorado Department of Human Services because they have serious and persistent mental health conditions. Forensic clients include those who are charged with a crime and have a mental or developmental disability that prevents them from assisting in their own defense or rationally understanding the criminal court proceedings, and those who have been charged with a crime but found not guilty by reason of insanity. CFMH works across the legal system to provide evaluations, treatment and case management for these clients. Outpatient Services is the newest part of this continuum, working to support clients stepping down or being diverted from hospitals and jails, and giving them the care they need in the community.

Through our core values listed below, Outpatient Services staff is committed to:

• Individual dignity and respect
• Person-centered, evidence-based care
• Trauma informed recovery
• Multidisciplinary collaboration
• Diversity and inclusion
• Strong family and community partnerships

Weekly Hybrid Working Arrangements

Minimum 2 days in the office and Maximum 3 days of remote work

Monday - Friday 8:00 AM to 5:00 PM

This position will comply with the Civil and Forensic Mental Health - Outpatient Services current working arrangements.

Please note: Work arrangements are subject to change at any time.

What You'll be Doing:

Quality Assurance Auditor/Program Evaluation Work Lead:

• Forms, leads, and maintains the OSDV Credentialing Committee, in alignment with NCQA standards, and leads program directors to support these efforts.
• Oversees the work of payer enrollment for all of OSDV, ensuring staff compliance.
• Leads quality and compliance audits, evaluation, and analysis to OSDV.
• Presents data and relevant findings to OSDV and CFH leadership, as well as internal or external stakeholders, as directed by the Division Director.
• Uses audits and program evaluations to lead clinical quality and continuous quality improvement of services provided to the Division’s clients and supports decision-making with relevant results and analyses that influence positive outcomes.
• Partners with leadership to identify benchmarks for their programs to maximize effectiveness with the clients served.
• Audits programs to these benchmarks and division-wide standards and provides feedback to leadership regarding problem areas in operating procedures and standards across various locations and settings.
• Reviews and evaluates organizational policies, practices, structure, functions, programs, work methods, resources, and program performance and formulates solutions to increase the efficiency and effectiveness of Forensic Services.
• Performs internal case audit and analysis for compliance with Consent Decree requirements, department benchmarks, and department standards and protocols.
• Has experience working with the SMI population, and is knowledgeable about research-based SMI treatments, evidence-based effective principles for intervention, and quality auditing practices.
• Performs internal review to align operations and practice with BHA rule, statute, and Federal law, as applicable.
• References and regards professional ethical codes and board rules governing the practice of the Outpatient Clinic treatments, and brings findings, both positive and negative, to leadership to influence practice, quality, and compliance.
• Work lead for 20 FTE; guiding, coaching and mentoring subordinate staff.
• Provides input into performance plans and evaluations and works in collaboration with the supervisor.

Change Management and Data Analyst

• Leads and identifies areas for improvement; identifies the issues related to process improvement; and be successful in communications and recommendations for change by reviewing program documents, policy updates, and conducting chart audits.
• Works closely with teams, individuals, and leaders within Outpatient Services to successfully affect change management and process improvement with current practices. If additional data or statistical analysis is needed this position works with the information management team to ensure data is presented timely.
• Operates independently in performing professional tasks. This includes performing complex, cross functional, division-wide projects or initiatives to improve processes or outcomes.
• Tracks performance against established goals and makes associated recommendations to maximize performance. New processes or objectives are reviewed with leadership.
• Responsibilities include working with staff and leaders, evaluating and providing suggestions to processes and must possess the ability to lead without direct authority over others.
• Responsible for the ongoing efforts of the quality of processes and programs.
• Collaborates and uses skills to communicate process change with staff.
• Required to use diplomacy and professionalism while working with internal stakeholders representing Outpatient Services.
• Collaborates with leadership to develop their program and process auditing and compliance tracking system to assure that Outpatient Services is complying with federal regulations, state statutes, policies and standards and Consent Decree, and Statutory requirements.
• Analyzes and monitors the effectiveness of problematic approaches and identifies avenues to improve practices.
• Program analysis is identifying deficiencies or barriers and reaching a conclusion to be presented to leaders.
• In collaboration with leaders, provide formal feedback and consultation to staff in reflection of all audits and work reviews.
• They may be required to participate in committees or work groups to provide program guidance and clarification, and provide input on issues that have a direct impact on the program.

Work Lead Quality and Compliance Training

• Leads and has a unique level of expertise in the quality, rules, and regulations that is critical for the success of the division. Leaders and staff recognize and seek the technical guidance and direction from this position.
• Leads and assists in the facilitation and training across Outpatient Services for continuous quality improvement initiatives.
• Facilitates and leads continuous improvement efforts (workshops, training, and coaching) using methods for data gathering and analysis, problem solving, project management and professional presentation skills.
• Determines and implements training within Forensic Services to deliver specific training and technical assistance.
• Develops instructional guidance to provide direction on consistent implementation to intra-agency departments within Forensic Services.
• Has the ability to interpret and communicate results to all audiences.
• Communicates and teaches process improvement methods, tools, techniques, and best practices to staff within Forensic Services and develops communication and training materials in alignment with department strategies or policies.
• Creates and presents process improvement techniques and improvement results to various audiences.
• Is the work lead for 20 FTE; guiding, coaching and mentoring subordinate staff.
• Provides input into performance plans and evaluations and works in collaboration with the supervisor.

Other Duties as Assigned

• May be called upon to perform tasks or undertake special assignments or projects deemed necessary by OCFMH, but not specifically referenced in the above duties.

Experience Only

Seven (7) years of experience in behavioral/mental health clinical work or leadership, healthcare quality, or a similar field.

Education and Experience

A combination of education in behavioral health, healthcare administration, quality management or related field and/or experience in behavioral/mental health clinical work or leadership, healthcare quality, or a similar field equal to seven (7) years.

Preferred Qualifications

• Knowledge of 27-65 statute, behavioral health regulations, and/or billing and claims law and rule.
• Knowledge of and experience with HIPAA and 42 CFR part 2.
• Previous experience with or detailed knowledge of NCQA credentialing standards.
• Previous experience with and knowledge of BHA rules.
• Previous experience with clinical chart audits and documentation requirements.
• Previous experience with critical incident reporting.
• Relevant years of State service.

Conditions of Employment

• Full background check and reference check required.
• This position requires State of Colorado residency at the time of application (unless otherwise identified in the posting), and residency within the state throughout the duration of employment in this position.
• Comply with all vaccination requirements that are required by CDHS; TB testing must be completed.
• Former State employees who were disciplinarily terminated or resigned in lieu of termination must:

1. Disclose that information on the application.
2. Explain why the prior termination or resignation should not disqualify you from the current position.
3. Provide your employee number from your prior State employment. Absent extraordinary circumstances, prior disciplinary termination or resignation in lieu of termination and failure to provide this information will disqualify the applicant from future State employment with CDHS.

About Us & Benefits

• Strong, secure, yet flexible retirement benefits including a PERA Defined Benefit Plan or PERA Defined Contribution Plan plus 401(k) and 457 plans
• Medical and dental health plans
• Employer supplemented Health Savings Account
• Paid life insurance
• Short- and long-term disability coverage
• 11 paid holidays per year plus vacation and sick leave
• State of Colorado Employee BenefitHub Resource Center
• Employee Wellness program
• Excellent work-life programs, such as flexible schedules, training and more
• Remote work arrangements for eligible positions
• Some positions may qualify for the Public Service Loan Forgiveness Program.

Our Values

• We believe in a people-first approach: We prioritize the needs, well‑being, and dignity of the individuals, families and communities we serve. We commit to respect, fairness and access in every decision, policy and interaction. We engage client voices and experiences in the development and implementation of the services we provide.
• Balance creates quality of life: We want our team to be resilient through a supportive workplace that values flexibility, health and wellness, and employee engagement.
• We hold ourselves accountable: We take responsibility through our actions, programs, and results for the state of health and human services in Colorado.
• Transparency matters: We are open and honest with employees, our partners, the Coloradans we serve, and the public.
• We are ethical: We abide by what is best for those we serve by doing what is right, not what is easy.
• Collaboration helps us rise together: We work together with all partners, employees, and clients to achieve the best outcomes for Coloradans.

ADA Accommodations

CDHS is committed to a Colorado for ALL qualified individuals. As part of this commitment, our agency will assist individuals who have a disability with any reasonable accommodation requests related to employment.

This includes completing the application process, interviewing, completing any pre-employment testing, participating in the employee selection process, and/or performing essential job functions where the requested accommodation does not impose an undue hardship. If you have a disability and require reasonable accommodation to ensure you have a positive experience applying or interviewing for this position, please direct your inquiries to [e-mail].

EEO Statement

The State of Colorado is an equal opportunity employer.

We are committed to increasing a "Colorado for ALL" of our staff and providing culturally responsive programs and services. Therefore, we encourage responses from people of all backgrounds and abilities. The State of Colorado believes that a "Colorado for ALL" drives our success, and we encourage candidates from all identities, backgrounds, and abilities to apply. The State of Colorado is an equal opportunity employer committed to building inclusive, innovative work environments with employees who reflect our communities and enthusiastically serve them. Therefore, in all aspects of the employment process, we provide employment opportunities to all qualified applicants without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity or expression, pregnancy, medical condition related to pregnancy, creed, ancestry, national origin, marital status, genetic information, or military status (with preference given to military veterans), or any other protected status in accordance with applicable law.

Additional Support For Your Application

Toll Free Applicant Technical Support: If you experience technical difficulty with the NEOGOV system (e.g. uploading or attaching documents to your online application) call NEOGOV technical support at 855-524-5627 Mon-Fri between 6 am and 6 pm (Pacific Time). Helpful hints: if you are having difficulty uploading or attaching documents to your application 1) ensure your documents are PDF or Microsoft Word files and 2) close the document before you attempt to upload (attach) it.