State Quality Control Reviewer II
State Quality Control Reviewer II
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Job Description
Introduction
Make a Difference with DHSS
Our mission at the Department of Health and Social Services (DHSS) is to improve the quality of life of Delaware citizens by promoting health and well-being fostering self-sufficiency and protecting vulnerable populations. We prioritize personal and family independence by assisting individuals and families in a variety of life areas.
We offer numerous career opportunities and are dedicated to attracting and retaining highly talented individuals who are ready to make a difference in their community today. DHSS is a great place to kick-start your profession.
For more information please visit today!
Summary Statement
Essential Functions
- Conducts reviews of case files records and supporting documentation to determine the accuracy of client eligibility factors and public assistance payments within prescribed timeframes using quality control methodology.
- Interprets explains and ensures compliance with state or federal laws rules and regulations approved waivers as well as program requirements.
- Researches identifies and reviews relevant records or documents and conducts interviews of clients which may include visiting residences to obtain and clarify information.
- Performs mathematical computations of income resources and expenses to determine the accuracy of benefits payments including re-calculation of regulatory formulas and household budgets; incorporates factors such as fluctuating earnings child support shelter costs utilities childcare/medical deductions taxes and insurance.
- Ensures data validity and evaluates program performance through a variety of quality control methods such as root cause analysis.
- Identifies factors that cause or contribute to errors discrepancies and non-compliance and makes recommendations for corrective action and improvements based on findings.
- Prepares and submits program reports that clearly and accurately document findings supporting facts and actions taken.
- Completes continuing education to remain current on quality assurance standards methods techniques and best practices in assigned public assistance programs.
- Uses automated information systems and computer software to research review analyze document and report on public assistance case information.
- Issues recommendations from reviewed cases for future error reduction strategies and improvements to program integrity and escalates cases of suspected fraud.
- Attends fair hearings as needed testifying to explain findings and calculations of reviewed cases.
- Communicates and interacts effectively with people across cultures ranges of ability genders ethnicities ages and races.
- Performs related work as required.
Job Requirements
JOB REQUIREMENTS for State Quality Control Reviewer II
Applicants must have education training and/or experience demonstrating competence in each of the following areas:
- Two years experience in interviewing which includes using structured or unstructured interview techniques to obtain facts explore issues and identify courses of action.
- One year of experience in quality improvement such as evaluating the quality of services identifying problems and needs and recommending corrective action and improvements to ensure optimum service delivery goals and objectives are met and in compliance with applicable laws rules regulations and standards.
- One year of experiencein researching compiling and analyzing data to make recommendations for continuation or changes to operations programs services policies or procedures based on findings.
- One year of experience in determining compliance with laws rules regulations standards policies and procedures.
Additional Posting Information
The State of Delaware recognizes the value oftelework and flexible working schedules. This position is eligible for Telework and Alternative Work Schedules according to the State of Delawares Alternative Work Arrangement Policy. More information will be shared at the time of interview.
Conditions of Hire
As a condition ofhire you must possess a valid drivers license (not suspended revoked or cancelled or disqualified from driving).
Applicants must be legally authorized to work in the United States. The State of Delaware participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S. For more information refer to ourJob Seeker Resources.
DHSS does not provide employment-based sponsorship.
Benefits
To learn more about the comprehensive benefit package please visit our website at Process
The application and supplemental questionnaire are evaluated based upon a rating of your education training and experience as they relate to the job requirements of the position. It is essential that you provide complete and accurate information on your application and the supplemental questionnaire to include dates of employment job title and job duties. For education and training list name of educational provider training course titles and summary of course content. Narrative information supplied in response to the questions must be supported by the information supplied on the application including your employment education and training history as it relates to the job requirements.
Once you have submitted your application on-line all future correspondence related to your application will be sent via email. Please keep your contact information current. You may also view all correspondence sent to you by the State of Delaware in the My Applications tab .
Accommodations
Accommodations are available for applicants with disabilities in all phases of the application and employment process. TDD users may request an auxiliary aid or service by calling or by visiting . You may also call or email for additional applicant services support.
The State of Delaware is an Equal Opportunity employer and values a diverse workforce. We strongly encourage and seek out a workforce representative of Delaware including race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression.
Employment Type
Full-Time
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