Senior Clinical Quality Specialist

Job Title: Senior Clinical Quality Specialist

Job Summary:

CASES is looking for a Senior Clinical Quality Specialist to assist in the implementation of continuous quality improvement and program performance evaluation of CASES programs. The ideal candidate is experienced in the standards of care, regulatory body policies, and regulations administered by the New York State Office of Mental Health (OMH), NYS Office of Addiction Services and Supports (OASAS), NYC Department of Health and Mental Health (DOHMH), NYS Office of the Medicaid Inspector General (OMIG), NYS Department of Health (DOH), NYC Mayor's Office of Criminal Justice (MOCJ), Health Insurance Portability and Accountability Act (HIPAA), 42 CFR Part 2 Confidentiality for Substance Use Disorder Treatment, NYS Justice Center for the Protection of People with Special Needs, Health Home Care Management, and Medicaid Managed Care Organizations (MCO).

The Senior Clinical Quality Specialist will be experienced in in trauma-informed practices, assessment, treatment planning, harm reduction, diagnosis, client documentation, incident reporting, person-centered care, training, treatment of people living with serious mental illness, co-occurring substance use disorders, co-morbid medical conditions, and assistance for justice- involved individuals. The Senior Quality Specialist will exhibit a proficiency of social service/non-profit knowledge related to evidence-informed practices, standards of client documentation, incident reporting procedures, and client outcomes that elevate clients living with serious mental illness, co-occurring substance use disorders, co-morbid medical conditions, and justice involvement.

The ideal candidate is a responsive, detail-oriented team player who is competent in a busy environment and is organized to handle competing deadlines. A person with excellent organizational, analytical, problem-solving and communication skills will thrive in the role. The ideal candidate will enjoy training and coaching others in standards of care, compliance, and continuous quality improvement.

This is a remote position with requirements and expectations to be in the office for regulatory audits, stakeholder presentations, monthly meetings that require in-person participation, and the delivery of staff training. When working in-person the Senior Quality Specialist will be onsite at a CASES office in Central Harlem, South Bronx, Court, and Downtown Brooklyn.

Salary: The salary for the Senior Clinical Quality Specialist is $80,500.00 annually.

Shift Hours: The Senior Clinical Quality Specialist is full-time Monday through Friday 9am-5pm shift.

Location Address: 25 Chapel Street, 11th Floor, Brooklyn, New York 11201.

Workplace Flexibility: Hybrid - 1 day remote per week.

What you will be doing:

• Demonstrate interpersonal effectiveness in alignment with CASES values and mission
• Coordinate and support the incident reporting practice across the CASES programs in accordance with regulatory policies and internal procedures
  • Co-facilitate incident committee meetings to review and monitor the program response to incidents and assess risk
  • Monitor compliance of incident reporting, incident review committees, and corrective action implementation. Complete incident review meeting minutes, follow-up procedures and practices
• Demonstrate the ability to distil complex and sensitive information reported during incident review committee meetings, providing:
  • Accurate, timely minutes, and coordination of follow-up procedures and practices. Ensure incidents are thoroughly documented, investigated, and appropriately reviewed
• Conduct internal chart review and audits to confirm client records meet standards of care, licensing, medical necessity, State and MCO Medicaid regulations
• Complete timely utilization review (UR) of client documentation for medical necessity admission and continuing stay, and discharge reasons; develop recommendations shared with managers and monitor how UR decisions are implemented by the treatment team
• Monitor regulatory and internal compliance procedures of CASES programs to maintain client privacy and release of confidential protected healthcare information, including HIPAA and 42 CFR Part 2 Confidentiality for Substance Use Disorder Treatment
• Assist the Quality team with documenting and complying with special investigation policies and client grievances, while maintaining a high level of confidentiality and reporting accuracy
• Coordinate continuous quality improvement (CQI) initiatives and projects with CASES programs, monitoring program performance and client outcomes for trend analysis
• Assist the delivery of training and staff coaching on CASES policies and procedures, , incident reporting, and standards of care, monitoring compliance with local, state, and federal regulations
• Conduct internal chart reviews and audits to confirm client records meet standards of care and regulatory/stakeholder requirements
• Serve as Special Investigator with the Director of Quality -for reports of abuse and neglect made to the Justice Center
• Support periodic review and revision of policies and procedures, and updates to the electronic health records (Foothold, AWARDS, Qualifacts, CareLogic, ECM/Salesforce)
• Other duties as assigned by the Director of Quality

'What we are looking for:

• Licensed Master Social Worker/Licensed Mental Health Counselor or Graduate Level
• Degree with at least 3 years of quality improvement/assurance and compliance experience with NYS licensed treatment programs
• Maintain a high degree of accuracy along with attention to detail
• Prioritize assignments and meet stringent deadlines
• Exhibit a high proficiency of critical thinking skills to independently respond to incidents
• Ability to provide strengths-based constructive feedback, deal with sensitive issues, and maintain confidentiality, all with a focus on improved quality
• Excellent verbal, written, presentation, and interpersonal skills
• Proficient with MS Office (Word, Excel, PowerPoint, Outlook, OneDrive, Teams, and SharePoint).

Employee Benefits:

CASES cares about employee wellbeing, and we offer a comprehensive benefits package to support you and your family, including:

• Medical
• Dental
• Vision
• Vacation and Paid Time Off - starting at 25 days
• 12 Paid Holidays per year.
• Retirement 403(b) Competitive matching up to 6%.
• Employee Referral Program

Monday - Friday, 9am to 5pm
35 hours per week excluding breaks