JOB DESCRIPTION
POSITION: Behavioral Health Quality Assurance Manager
DEPARTMENT: Community Wellness Department
REPORTS TO: Clinical Director of Behavioral Health
LOCATION: Native American Health Center, Inc. (NAHC) – Multiple
333 Valencia St, San Francisco, CA 94110
3124 International Blvd, Oakland, CA 94601
WORK HOURS: Full Time, 100% FTE, 40 Hours per Week
STATUS: Non-Union, Non-Exempt
Indian Preference Act: Preference in hiring is given to qualified Native Americans in accordance with the Indian Preference Act (Title 25, US Code, Section 472 and 473). Applicants claiming Indian Preference must submit verification of Indian heritage certified by tribe of affiliation or other acceptable documentation of Indian heritage.
POSITION SUMMARY
NAHC is seeking a smart, capable, energetic individual to work closely with the Clinical Director of Behavioral Health, the Director of Community Wellness, and site staff to lead development and oversight of EPSDT/Mental Health Medi-Cal and other third-party insurance and revenue streams for our San Francisco and Oakland based behavioral health services. Community Wellness Department supports multi-site programming and provides services in 3 Bay Area Counties at 5 locations (2 in SF, 2 in Oakland, 1 in Richmond) to urban American Indian, Alaska Native, other Indigenous people, as well as diverse members of the surrounding communities. Services are rooted in a holistic service provision model that integrates prevention, whole health, community-engagement, cultural-competence, and behavioral health treatment.
DUTIES AND RESPONSIBILITIES
1. Act as a liaison between the agency and contracting counties regarding all quality assurance tasks including contract objectives, documentation standards, licensing, audits, and other county requirements.
Provide weekly report to the Behavioral Health Director, Site Manager, and Community Wellness Director on all QA processes for each program.
Oversee internal quarterly audits of charts, looking for accuracy, completion, quality, and compliance with internal and external regulations; provide summaries and feedback to managers; identify and follow up on plans of correction.
Facilitate unannounced quality assurance reviews; develop feedback reports for Program Directors and Supervisors.
Oversee a quarterly Peer Utilization Review for direct service staff; develop processes and procedures for ongoing quarterly peer reviews of clinical charts and produce summary reports and feedback based on the reviews
Develop a database and system that will ensure easy access to reports requested by program directors and external agencies.
Oversee the process for new and closed charts including tracking, printing, filing, and storage.
Provide support to direct service staff in the efforts to complete charts by specified deadlines and to meet Medi-Cal standards.
Ensure compliance with HIPAA requirements.
Assist in billing procedures for behavioral health programs.
Work with County Staff to credential staff and inform managers of changes in county policy and procedures.
Develop a system to regularly monitor Medi-Cal status for all clients enrolled in the program.
Responsible for training new staff on office policies and protocols related to quality assurance and improvement.
Assist in development and evaluation for outcomes across the agency.
Manage paperwork related to NAHC trainings.
Maintain outcome data for the agency that includes the following:
Examination of aggregate data on outcomes,
Identification of potential problem and/or patterns of outliers.
Prepare an annual report on agency and county required outcomes.
Assist with contract renewal processes and updating program materials.
Support and participate in relevant workgroups and meetings as assigned, and ensure appropriate distribution of information to relevant personnel.
Employee Safety: Safely performs all duties; follows required protective protocols to ensure personal safety as well the safety of others.
Must maintain compliance with ergonomic safety standards; be mindful of posture and regularly practice ergonomic stretches.
Quality Improvement:Actively participate in internal quality improvement teams and work with members proactively to drive quality improvement initiatives in accordance with the mission and strategic goals of the organization, federal and state laws and regulations, and accreditation standards, when assigned.
Work well under pressure, meet multiple and often competing deadlines.
At all times demonstrate cooperative behavior with supervisors, subordinates, colleagues, clients and the community.
Other duties as assigned by Supervisor.
MINIMUM QUALIFICATIONS
Master’s degree in social work, psychology, public health, public policy, business or related field. California licensure as LCSW, LMFT, PsyD, or PhD is preferred.
Five years of experience behavioral health billing, including understanding of Federal, State and Local regulations.
Minimum of three years providing supervision and coaching.
A thorough working knowledge of Medi-Cal regulations and requirements. Willingness and ability to become the agency expert at Medi-Cal regulations and the policies and procedures for each of our contract counties. Must be able to read and accurately interpret complex compliance and regulation guidelines. Must be able to develop a thorough working knowledge of county billing systems.
Proven experience utilizing the Plan-Do-Study-Act model.
Experience with E.H.R. and accreditation in a behavioral health system.
Strong clinical knowledge.
Excellent analytic skills.
Excellent written, verbal and interpersonal skills.
Advanced knowledge of Windows Microsoft Office, internet, and databases.
Ability to work collaboratively with a broad range of constituents. Must be able to respond to common audits, inquiries, or complaints from regulatory agencies.
Experience and ability with underserved and/or multicultural populations.
Knowledgeable about substance abuse and mental health among American Indian/Alaska Native/other Indigenous populations.
Benefits:
Native American Health Center (NAHC) considers our employees to be our most valuable resource and offers an excellent benefit package: competitive salaries, personal time off (PTO) or sick/vacation leave program, and an employer contribution 403(b) retirement plan to full-time regular status employees. We also provide medical, vision, dental, flexible spending, group term and voluntary life insurance coverage for employees and their dependents—with a percentage of employee contribution for dependent medical premiums.
Note to Applicants:
Please be advised a post job offer, pre-employment Physical and TB test are required as a condition of employment.
Additionally, you may be asked to get a Department of Justice Fingerprinting clearance as a contingency for an offer of employment. Criminal clearances are obtained to protect the welfare and safety of clients receiving services at NAHC.
EQUAL OPPORTUNITY EMPLOYER: Within the scope of Indian Preference, all candidates will receive equal consideration without regard to race, color, gender, religion, national origin or other non-merit factors.
Age Discrimination in Employment Act (ADEA): Native American Health Center abides by the mandates of the ADEA (protecting individuals 40 years and older) and considers age a non-merit factor in all employment decisions and considerations.
Americans with Disabilities Act (ADA): Native American Health Center abides by the mandates of the ADA and considers disability a non-merit factor in all employment decisions and considerations. Furthermore, NAHC will make any practical, feasible, and reasonable arrangements to accommodate qualified applicants and employees with disabilities.
How to apply
If interested, please complete our employment application located on our website www.nativehealth.org and submit along with a copy of your resume and cover letter to:
Human Resources
3124 International Blvd.
Oakland, CA 94601
Fax: 510.748.0116
Email: Jobs@nativehealth.org