Quality Management Specialist

ChangePoint Integrated Health Centers; Show Low (AZ); On-site; USD 42,000 - 65,000; Full time

Job summary

ChangePoint Integrated Health Centers is seeking a Quality Management/Utilization Management Specialist (QM/UM Specialist) to conduct chart reviews, monitor regulatory compliance, and assist in QM/UM planning. This non-exempt role collaborates with leadership to ensure quality and safety across medical records and utilization management processes.

The position requires a High School Diploma, Arizona driver’s license, and 1 year in behavioral health, with preferred Bachelor's in behavioral health

Qualifications

• High School Diploma required.
• Current Arizona Driver's License required.
• 1 year experience in a behavioral health agency.
• Must comply with Drug Free workplace.
• Must be 21 years of age.

Responsibilities

• Adhere to personnel policy and comply with agency requirements for ethical and professional behavior.
• Participate in QM System implementation and in the development of the annual Evaluation and Plan.
• Assist in implementing hospital QM and UM systems and developing the annual Evaluation and Plan.
• Assist in development and revision of policies and procedures as needed.
• Be a resource to clinicians and administrative staff regarding record standards.
• Produce verbal and written reports and visual graphs reflecting data analysis.
• Work as a team to help staff understand and comply with record standards.
• Be accurate, efficient, and complete in documentation.
• Support the company, patients, families and co-workers through quality management activities.
• Perform chart reviews and audits as needed.
• Review and release of medical records ensuring HIPAA rules and regulations are adhered to.
• Promote quality and safety to maintain a safe and pleasant work environment.
• Perform other duties as assigned by supervisor.

Skills

English fluency

Verbal and written communication

Analytical skills

Time management

Team player

Documentation accuracy

Education

High School Diploma

Bachelor's Degree in Behavioral Health or related

Tools

Microsoft Office

Job description

TITLE: QUALITY MANAGEMENT/UTILIZATION MANAGEMENTSPECIALIST (QM/UM SPECIALIST)

STATUS: NON-EXEMPT

LINESOF AUTHORITY: This position is supervised by the Quality Manager. This position does not supervise staff butworks collaboratively with supervisors to provide feedback regardingutilization management for the hospital, quality management and clinical recordinformation for ChangePoint Integrated Health.

POSITIONSUMMARY: This position is responsible for conducting record reviews for recordsrelease and for monitoring compliance with regulatory agencies and assisting inwith the monitoring of the hospital's QM Plan, UM Plan, and ChangePoint's QMPlan at the direction of the Director of Quality Management.

PRINCIPLEDUTIES/RESPONSIBILITIES:

• 1. Adhere to personnel policy and comply withagency requirements for ethical and professional behavior.
• 2. Participate in the implementation of the QM System, and assist in the development of the annual Evaluation andPlan.
• 3. Participate in the implementationof the hospital's QM and UM system, and assistin the development of the annual Evaluation and Plan.
• 4. Assist in the development and revision ofpolicies and procedures as needed.
• 5. Be a resourceto clinicians and other administrative staff in regards to basic
• 6. Able to produce verbaland written reports, and visual graphs to reflect data analysis.
• 7. Work as team playerassisting staff with various skill levels and backgrounds to understand and comply with record standards.
• 8. Must be accurate, efficient and complete in documentation.
• 9. This position requires positive and activesupport of the company, Patients, families and co-workers.
• 10. Mustparticipate in quality management and quality improvement activities.
• 11. Responsible for performing chart reviews andchart audits as needed.
• 12. Responsible for the review and release ofmedical records, ensuring that all HIPPArules and regulations are adhered to in the process.
• 13. Promotes quality and safety to help maintain asafe and pleasant work environment, follows safety regulations, andactively contributes towards a
• 14. Perform other duties as assigned by supervisor.

PRIMARY CONTACTS:

• Regularreview of clinical records (electronic and written).
• Interfaceregularly with Chief OperationsOfficer, Hospital Administrator, Medical Director, Quality Manager,Compliance Director and other supervisors.
• Periodicinterface with regulatory and accrediting bodies/employees.

POSITION REQUISITES:

Qualifications andExperience

Required:

• High School Diploma
• Current Arizona Driver's License.
• Oneyear experience working for a behavioral health agency.
• Complywith a Drug Free workplace.
• Must be 21 years of age.

Preferred:

• BHTpossessing a Bachelor's Degree or higher
• Twoyears of experience working for a behavioral health agency.

Skills/Abilities

Required:

• Ableto work within a multi disciplinary structure.
• Ableto employ Quality Management theory and techniques.
• Strongverbal and written communications skills.
• Basicknowledge of resources related to regulations.
• Strongorganizational and time management skills.
• Ableto interact effectively with supervisors and employees.
• Fluentin English both verbally and in writing.
• Literate.
• Ableto effectively employ analytical and problem-solving skills.
• Abilityto work forty (40) hours per week.
• Ableto use various computer software programs to produce high quality report andgraphs, tables.

WORKING CONDITIONS:

Physical Requirements

• Able to sit and standfor extended periods of time, less frequently, walking, lifting and reaching.
• Able to hear ordinaryconversation and phone communications.
• Visual capacitynecessary to fulfill documentation, responsibilities of job.

Emotional Capabilities

• Able to provide verbaland written feedback, including negative feedback, to employees and supervisorsrelated to clinical record reviews and other QM monitors.

Equipment Operation

• Able to operate generaloffice equipment, including computers.
• Able to operate Companyvehicles.

Environmental Conditions

• Air conditioned and/orheated office setting.

Accommodations(s)

• Will accommodate asappropriate and reasonable.

CONFIDENTIALITY LEVEL:

I understand that Stateand Federal Laws strictly prohibit unauthorized access, use, modification,disclosure, or destruction of confidential, sensitive or protected healthinformation. Penalties for violation mayinclude ChangePoint disciplinary action, including termination of employment,and/or criminal or civil action.