Under direction of the Behavioral Health Director or designee; the Quality Care Management and Systems Performance Manager serves as a member of the Behavioral Health Executive Team helping to clarify program objectives, Network Adequacy requirements, fiscal objectives and target populations to be served; provides analysis of the program structures of the services system and assists in the interpretation of empirical findings. The incumbent will act as liaison to and will respond to the Department of Health Care Services (DHCS), and other agency queries regarding the status and scope of plan activities.FLSA: Exempt
Essential Job Functions
- Analyzes existing quality improvement activities throughout the Department of Behavioral Health and in developing the Quality Management/Utilization Management Plan, Annual Quality Improvement Work Plan and Quality Assessment and Performance Improvement Plan.
- Monitors compliance with Medi-Cal and other standards and requirement of the California Code of Regulations for a Mental Health Plan and Drug Medi-Cal System.
- Develops implementation processes for components of the Quality Management Plan.
- Works with the Behavioral Health's department policy and procedure coordinator to develop policies and procedures to comply with changes in the plan and with federal and state legislation and regulations.
- Conducts program site reviews on an annual basis; conducts on-site reviews with contract providers on a bi-annual basis for Medi-Cal re-certification purposes, to ensure County guidelines are being followed.
- Assists the Department Leadership Team and Assistant Director by coordinating reviews conducted by the California Department of Health Care Services and other authorized entities, and assists mental health staff to prepare for review sessions.
- Assists the Compliance Officer and/or Leadership Team of the department and program operations with developing and coordinating corrective action plans to address any findings from reviews.
- Reviews and analyzes findings of internal program reviews and external audits to identify problem areas.
- Identifies new components or activities required in the Quality Improvement Work Plan and directly works to implement the goals within the QI work plan.
- Oversees the data collection, reviews and analyzes data to identify trends and issues across the County mental health and substance use disorder system and makes recommendations.
- Maintains and compiles statistical records and profiles of quality improvement activities.
- Develops and presents, or works collaboratively with the department system training coordinator, quality management training related to changes in regulations and requirements to enhance skills of mental health program staff involved in quality improvement activities.
- Serves as a member of the Quality Assurance, Program Improvement (QAPI), Performance Improvement Plan (PIP) Stakeholder group, Program implementation/fiscal department/department's contracts division, Psychiatric Health Facility (PHF) UR Committee, Compliance Committee, Quality Improvement Committee, Data Management Team, Leadership, or other committees, task forces, or groups, as necessary.
- Provides consultation to both County and contracted programs on quality management and improvement matters.
- Monitors and reviews the work of staff assigned to perform quality assurance and quality improvement duties to ensure compliance with State and Federal regulations.
- Oversees system-wide quality improvement monitoring processes including, but not limited to, medical records review, site reviews, peer reviews, medication monitoring, serious incident reporting, and utilization review.
- Convenes the Quality Improvement Committee.
- Updates plans as needed to comply with new regulations or interpretations.
- Provides responsive, high quality service for County employees, representatives of outside agencies and members of the public by providing accurate, complete and up-to-date information, in a courteous, efficient and timely manner.
- Acts as a liaison with the State Department of Mental Health and other agencies with regard to the Behavioral Health Care Service Managed Care Plan; monitors contract compliance and acts as liaison to enforcement agencies.
- Keeps informed of laws, regulations, accreditation and licensure standards pertaining to quality assurance, outpatient and inpatient care, continuing care and other program operations for both mental health and alcohol and drug programs.
- Supervises and directs staff as appropriate.
- Performs other related duties as assigned.
- Possession of a valid license as a Licensed Clinical Social Worker (LCSW), or Licensed Professional Clinical Counselor (LPCC), or Licensed Marriage and Family Therapist (LMFT) issued by the California Board of Behavioral Sciences, or Master's level Registered Nurse, or Clinical Psychologist issued by the California Board of Psychology,
- Three years (3) of post-licensure experience in utilization review, quality improvement activities or equitable experiences in a hospital or health care setting, including one (1) year of supervisory experience.
- Employees hired into this classification must file statements of economic interest with the Butte County Clerk/Recorder.
Environmental Factors and Conditions/Physical Requirements
- Work is performed in an office environment.