Behavioral Health Quality Assurance Manager

County of Nevada, CA July, 2015

BEHAVIORAL HEALTH QUALITY ASSURANCE MANAGER

DEFINITION

Under general direction, performs a variety of professional management activities in the planning, development, and implementation of the Nevada County Behavioral Health Quality Improvement Implementation Plan. This position is responsible for quality review and compliance in accordance with County policies and State performance contracts and Federal rules and regulations, and performs related work as assigned.

CLASS CHARACTERISTICS

This single classification position is responsible for professional level management activities including compliance with internal, state and federal regulations; the provision of high quality, cost-effective client care and the reduction of funding disallowances from funding sources due to improper charting and billing. Compliance monitoring includes Medicare, Medi-Cal, Americans with Disabilities Act, Mental Health Plan, and Mental Health Services Act and other associated state and federal regulations through the utilization review, quality improvement, cultural competency, fiscal operations and medical records programs and activities for all mental health and drug and alcohol programs within the Mental Health Division. The incumbent reports directly to the Director of Behavioral Health.

EXAMPLES OF DUTIES (Illustrative Only) Essential:

 Develop, coordinate and manage quality management and regulatory compliance functions.  Oversee and actively guide utilization review, medication monitoring, confidentiality of records and peer review in accordance with federal, state, and local government requirements.  Provide guidance to the Director, Behavioral Health, for focused review as it relates to mental health activities.  Work closely with Division managers in developing program policies which meet federal, state, and local government requirements. Provide lead direction to nursing staff regarding quality assurance programs and expected outcomes.  Prepare and implement the Quality Improvement Work Plan and two Performance Improvement Projects.  Plan and implement multi-faceted training for NCBH employees and contract providers and plan and implement State-mandated client satisfaction and provider satisfaction surveys  Participate in the planning and implementation of an Electronic Health record and billing system  Review and certify all network and organizational providers for compliance with state/federal Medi-Cal requirements and process all required filings for certification and recertification  Plan for, oversee and respond to the annual External Quality Review Organization review, Department of Health Care Services (DHCS) Medi-Cal audits, and other Department of Mental Health (DMH)/DHCS reviews  Oversee the Grievance and Appeal process and the Patient Rights Advocate for all client complaints, including requests for confidential patient information

 Plan and implement ongoing and periodic documentation reviews of NCBH departments, contractors, network and organizational providers  Participate with internal, external and partner agencies such as the Local Mental Health Board (LMHB) regarding compliance issues including regulatory, fiscal, and operational policies  Act as liaison with State Department of Mental Health, State Department of Alcohol and Drug Programs and regional quality management contractors.  Attend relevant state and regional meetings.

QUALIFICATIONS Knowledge of:

 Health care laws and regulations, including HIPAA.  Principles and practices of information privacy laws, access, release of information and release control technologies.  Principles and methods for practices of project planning, system analysis, monitoring, problem solving, implementation and evaluating, development and evaluation.

Skill in:  Developing and implementing goals, objectives, policies, processes, procedures, and work standards  Overseeing and performing complex problem definition and resolution activities.  Maintaining and directing the maintenance of accurate records, accounts and files.  Planning, supervising, reviewing and evaluating the work of staff through subordinate levels of management.  Identifying and solving accounting problems.  Communicating clearly both verbally and in writing.  Making presentations to the Board of Supervisors and others.  Organizing assigned work functions and processes; reviewing, evaluating, and modifying work methods.  Acting in a consultative manner with management.  Using initiative and independent judgment within general policy guidelines.  Establishing and maintaining working relationships with clients, customers, and representatives of other agencies or departments.

Education and Experience:

Bachelor's degree from an accredited college or university Nursing OR a Master's degree from an accredited college or university in public administration, health administration, mental health, or nursing. In addition to the educational requirements, four years of responsible experience in a supervisory, administrative, or managerial capacity working in any of the following areas: compliance, organizational development, human resources, quality assurance, quality control, fiscal operations or healthcare; including one year in a health or human services agency or comparable agency.

Licenses and Certificates: Eligibility to accrue hours for licensure in the professional area of one’s background. Eg., registered as an intern if pursuing licensure as a Marriage Family Therapist; or, be eligible to accrue hours of Supervised Professional Experience (SPE) as defined by the requirements of the Board of Psychology, if pursuing a PhD.

Possession of a valid California driver’s license within 30 days of hire.

Physical Demands and Working Conditions: Mobility and manual dexterity to work in a standard office environment, use standard office equipment and attend off-site meetings; speech and hearing to communicate in person and by telephone; vision to read handwritten and printed materials and a computer screen. Work may involve at-risk clients or those who pose a threat to self or others.

Some accommodation may be made for some physical demands for otherwise qualified individuals who require and request such accommodation.

Other Requirements: This class description lists the major duties and requirements of the job and is not all-inclusive. Not all duties are necessarily performed by each incumbent. Incumbents may be expected to perform job-related duties other than those contained in this document and may be required to have specific job-related knowledge and skills.

FLSA: E

Driver's License: Yes

Rev: 7/15