Compliance and Quality Assurance Specialist

Quality Assurance Specialist

Lead with Purpose and Elevate Quality Across Every Program

At Grafton Integrated Health Network were committed to ensuring individuals with complex needs receive the highest-quality support. As a Quality Assurance Specialist you play a key role in maintaining excellence by reviewing documentation monitoring compliance and partnering with teams to strengthen service delivery. Youll help foster a culture of accountability and continuous improvement providing clear feedback and guidance that supports both staff and the individuals we serve. And because we invest in those who drive our mission forward Grafton provides the tools and professional development you need to grow while making a meaningful impact.

Join us - and experience the deep fulfillment of knowing your work truly makes a difference!
Be part of a team that leads with heart and grit the Grafton waywhere leadership compassion and dedication come together to change lives.

The QA Specialist promotes and ensures protections of client rights; conducts investigations into allegations of abuse or neglect; supports activities to ensure compliance with regulatory and accrediting agencies; engages in activities to support the assigned region in continuous quality improvement initiatives; works collaboratively with other Quality Assurancepartners to coordinate department activities.

Essential Job Functions

• Implements qualitative and quantitative audits and related activities to assure compliance with applicable state and federal regulations and standards as well as contract requirements and payer stipulations including Medicaid requirements. Prepares and disseminates specialized data reports for management use. Stays current with relevant regulatory/Medicaid changes and serves as resource for answering related questions; Supports preparation activities for licensing surveys and other external reviews and supports activities during related review activities; Maintains licensure through the completion and submission of initial/renewal/modification of licensure applications.
• Conducts audits trainings and other activities to assure regional compliance with applicable accreditation standards such as CARF; Serves as on-site resource for questions pertaining to accreditation compliance; Supports preparation activities for accreditation surveys and facilitates on-site visits by accrediting body.
• Conducts audits to support regional and organization continuous quality improvement processes; Audits may involve areas such as client documentation physical environments and employee training; Provides audit findings to Executive Director and Quality Assurance and Compliance Director and monitors for completion of follow up actions identified; Produces data reports as requested by the Quality Assurance and Compliance Director or Executive Director.
• Reviews edits and closes Serious Incident reports within the organizations electronic client record (ECR); Ensures processing occurs of serious incidents with corrective action plans as needed; Collaborates with other department staff on the production of specialized reports for purposes such as tracking of processing identification of trends and in support of program development of action plans; Provides related information to members of the regional operating team including the Executive Director; Provides training and feedback to managers designated to write incident reports; Operates efficiently within the ECR to review client documentation and utilizes the Data Warehouse to generate/analyze reports to assure ongoing compliance.
• Receives reports of alleged abuse or neglect; Notifies applicable external agencies of allegations; Coordinates investigations with external agencies; Conducts internal investigations; Assures protection of clients rights including protection from harm and confidentiality; Prepares report of investigation findings and makes recommendations for corrective action; Engages in extensive professional communications and collaboration with all involved external investigative/ oversight agencies; Takes similar actions and holds equivalent responsibilities for any other serious incident involving a client that also includes investigation/oversight by an external entity.
• Makes external notifications of certain serious incidents as needed for compliance with regulatory standards and Medicaid and other payer requirements; This involves use of identified state electronic systems such as the reporting system for BIRFs; Stays current on changes to external reporting requirements and assures all required information and documentation are submitted within identified timeframes.
• Facilitates development of internal and external corrective action plans and monitors implementation of corrective action plans; provides status reports as requested to the Quality Assurance and Compliance Director and Executive Director; Analyzes trends related to citations and corrective actions and acts in accordance with findings.
• Acts as an objective party to hear concerns or complaints about alleged human rights violations; Investigates and facilitates resolution; Reports complaints as necessary to required external agencies; Facilitates external review of such matters; Assures information is entered into corporate tracking system including resolution of complaints and monitors related data for trends and consistency in processes organization-wide; Assures protection of clients rights through activities such as review of proposed restrictions consideration of program guidelines and activities monitoring use of pat downs and property searches and ongoing monitoring of implemented environmental/individual restrictions.
• Utilizes the organizations video camera system in accordance with Graftons policies and procedures; Assures the identified programs system is operating properly; Assures necessary recordings are saved in a confidential secure manner and are only released in accordance with policy and procedure and legally authorized processes.
• Receives reports of alleged abuse or neglect; Notifies Department of Social Services and licensing bodies of allegations of abuse or neglect; Coordinates investigations with external agencies; Conducts internal investigations; Prepares report of investigation findings and makes recommendations for corrective action.
• Receives andmaintainscopies of Serious Incident Notification forms; Ensures processing occurs of serious incidents with corrective action plans as needed; Produces aggregate data reports of regional serious incidents andsubmitsreports to Director Quality Assurance and Compliance regional management team and Executive Director.
• Makes external notifications of certain serious incidents asneeded for compliance withregulatory standardsand payor requirements.This may involveuseof external electronic systems.Conducts investigations into specific incidents andsubmitswritten reports toexternal entities as.
• May supervise one or more employees assuring training development and personnel needs are met for those individuals.
• Works in partnership with other Quality Assurance Supervisors to assure efficiency and effectiveness in fulfilling responsibilities.
• Provides employeeand clienttrainingon human rights related issues.
• Provides employee training on regulatory compliance Medicaid complianceandpolicies and proceduresas requested.
• Acts as resource to program managers in developing strategies for dealing with high-risksituations.
• Performs otherdutiesassigned.

MINIMUM QUALIFICATIONS

• Requires a Bachelors degree in a related field and a minimum of two years related experience providing and reviewing services investigating allegations of client abuse and neglect leading quality improvement initiatives or interpreting and applying licensure standards to human services programsOR
• HS/equiv. and a minimum of fiveyears experiencein the human services field with at least two years providing and reviewing services investigating allegations of client abuse and neglect leading quality improvement initiatives or interpreting and applying licensure standards to human services programs.
• Requires a valid driverslicense.
• Requires a working knowledge of applicableregulations.
• Completion of all requiredtrainings.Maintains all required annual certifications.

EMPLOYEE BENEFITS:

Caring for You So You can Care for Others:

• Medical dental and vision
• Flexible Spending & Health Savings Accounts
• Generous Paid Time Off plan & attendance incentives
• Employer Paid Life Insurance
• Employee Assistance Program (EAP)
• Short-term disability (STD)
• Long-term disability (LTD)

Stronger Together: Supporting Your Growth & Success:

• Paid Career Development - we pay you while becoming certified in CPR Ukeru Mandt and other career training!
• 401(k) including an employer match up to $2500 annually
• Education Assistance up to $5250 annually
• As Grafton is a 501(c)(3) non-profit you may be eligible for federal student loan forgiveness

If you have issues applying or have any questions about this position please reach out to us at

Grafton is an equal employment opportunity employer and tobacco-free workplace.

#LP

Required Experience:

IC