Overview
Services Quality Manager Jobs in Mount Pleasant, SC at Philips
Example of Duties
The following duties are typical for this classification. Incumbents may not perform all of the duties listed and/or may be required to perform additional or different duties from those set forth below to address business needs and changing business practices.
Assists in the design, implementation, and monitoring of quality assurance programs and policies to ensure compliance with federal, state, and local regulations.
Develops and delivers training programs to enhance staff understanding of quality assurance principles and compliance requirements.
Collects, analyses, and reports on data related to service delivery outcomes and process improvements.
Maintains documentation of complaints and grievances.
Reports outcomes and other data to the State as required by contract, law or regulations.
Monitors compliance with response timelines for access, treatment authorization requests and payment.
Develops, updates and monitors the cultural competency plan.
Monitors progress and develops reports required by the annual Quality Management Work plan.
Implements utilization review and quality assurance reviews; coordinates Quality Improvement Committee.
Serves on local and state committees or task forces.
Monitors agreements and contracts with providers as assigned.
Initiates, develop and revise written policies and procedures for quality management and compliance programs.
Participates in audits, reviews, and investigations of program operations and client services to ensure compliance with regulatory requirements.
Works closely with managers in developing program policies which meet federal, state, and local government requirements.
Maintains up-to-date knowledge of relevant laws, regulations, and best practices in quality management and behavioral health.
Attends relevant state and regional meetings.
Quality Management Specialist II
The Quality Management Specialist II performs the above duties but may be assigned more complex and difficult duties with limited supervision and direction.
Reviews and approves Treatment Authorization Requests (TARs) to assess eligibility criteria and ensure payment approval.
Authorizes 24-hour notifications for inpatient hospital placements.
Conducts concurrent reviews of placements to ensure compliance with established guidelines and best practices.
Reviews and signs off on documentation related to the progress and assessment notes of registered interns and student interns.
Provides oversight and ensuring compliance with the Peer Specialist documentation and program requirements.
Monitors charts for adherence to compliance standards, with an emphasis on preventing Fraud, Waste, and Abuse.
Reviews and approves diagnoses on 5150 evaluations and providing ongoing oversight of 5150 and crisis management protocols, when assigned to the Behavioral Health Division.
Conducts training sessions for clinical staff on new Behavioral Health Integration Notices (BHINs) and offering continuous support and guidance to all clinical personnel, when assigned to the Behavioral Health Division.
Minimum Qualifications
Knowledge of:
Behavioral health systems and related legislation.
Program planning, evaluation, needs assessment and quality review principles.
Federal, state, and local guidelines for utilization review and compliance.
Social Drivers of Health (e.g., housing, education, income, transportation, food security, and their influence on behavioral health outcomes and service delivery, as well as strategies for addressing these determinants.
Ability to:
Plan, organize, and coordinate program development and performance monitoring.
Develop and interpret policies, procedures, and regulations.
Community effectively and prepare clear, logical reports.
Build and maintain relationships with stakeholders.
Job Type: Full-time
Pay: $70,000.00 – $85,000.00 per year
Benefits:
401(k)
401(k) matching
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance
Schedule:
8 hour shift
Day shift
Work Location: In person
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Title: Services Quality Manager
Company: Philips
Location: Mount Pleasant, SC
