Offer summary

Qualifications:

Bachelor’s degree with 3 years of experience in utilization review, auditing, monitoring, credentialing, or quality management in mental health or substance use services., Proficiency in Microsoft Office and strong problem-solving skills., Ability to interpret laws, rules, and regulations related to healthcare services., Basic knowledge of mental health laws and regulations in North Carolina is a plus..

Key responsibilities:

Conduct on-site monitoring reviews of service providers to ensure compliance with federal and state regulations.

Collaborate with teams to schedule and prepare for monitoring activities and assist in contract compliance.

Provide technical support, training, and communication with providers and other departments.

Identify trends and develop interventions to improve service quality and address non-compliance issues.

Job description

Competitive Compensation & Benefits Package!

Position eligible for –

Annual incentive bonus plan
Medical, dental, and vision insurance with low deductible/low cost health plan
Generous vacation and sick time accrual
12 paid holidays
State Retirement (pension plan)
401(k) Plan with employer match
Company paid life and disability insurance
Wellness Programs
Public Service Loan Forgiveness Qualifying Employer

See attachment for additional details.

Location: Available for any Partners' NC locations; Remote option in NC or within 40 miles of NC border

Projected Hiring Range: Depending on Experience

Closing Date: Open Until Filled

Primary Purpose of Position: This position is responsible for the assessment of services delivered to consumers to ensure that services are consistent with funding requirements, best practices, provider contracts and federal/state rules and regulations. This position monitors provider agencies and independent practitioners within the provider network receiving reimbursement for service provision under the 1915(b)/(c) waivers and with State funding. Working with a team of reviewers/auditors, the Quality Management Monitoring Specialist will interpret monitoring results to identify trends/patterns that impact service/system quality, and then to implement interventions aimed at addressing these trends/patterns with the outcome of service delivery to consumers at the highest degree of quality.

Role and Responsibilities:

Schedule and perform on-site monitoring reviews of services delivered and documented by provider staff to assess their level of compliance with applicable Federal/State rules and regulations.
Coordinate/collaborate to schedule, prepare for and conduct various site monitoring reviews.
Assist with the implementation of contract requirements for agencies and licensed independent practitioners and the ongoing monitoring of these contracts for compliance.
Assist in enrollment of providers in the network according to parameters determined for qualifications and needs of the network for service providers through the site review process.
Assist members and families through participation in complaint/targeted monitoring reviews as requested. Serve as a resource to other departments within the LME/MCO on provider monitoring-related issues.
Participate in Provider Forums, Provider Orientations and provide technical support and assistance to Provider Council on monitoring related processes.
Visit provider agencies to facilitate communication, collaboration, and training in the monitoring processes.
Collaborates with the Quality Management Monitoring Manager and the Quality Improvement Committee (QIC) to complete reporting on all results obtained and will coordinate plans of corrections, payback, and the development of interventions to assist the Network with resolutions of identified non-compliances.
Monitor Employer of Record documents and processes to ensure that current, accurate rules/regulations are reflected, monitored, and met as intended.
The Quality Management Monitoring Specialist will encourage the development of Best Practices in the agencies of providers, addressing a comprehensive system of care which will utilize natural supports in the community through technical assistance, training, and clinical reviews.
This position provides technical assistance and training needed to assist providers in the implementation of the rules, regulations, and quality improvement processes required by the State and LME/MCO.
The Quality Management Monitoring Specialist also communicates with other departments within the LME/MCO and with various NC DHHS Departments, per rule requirements, to coordinate the Specialist’s activities and findings.
Other duties as specified by manager.

Knowledge, Skills and Abilities:

Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws, rules, and regulations to various situations; to apply regulations and policies for maintenance of consumer medical records, personnel records, and facility licensure requirements.
Demonstrates ability to work with other employees, the general public, provider owners and staff and to always exhibit a professional attitude.
Strong problem solving, negotiation, arbitration, and conflict resolution skills.
Must be able to act with tact and diplomacy in all situations.
Must be able to maintain strict confidentiality in all areas of work.
A working knowledge of the mental health laws and rules and regulations in North Carolina is a plus.
Excellent computer skills; proficient in Microsoft Office software.

Education and Experience Required: Bachelor’s degree and 3 years of utilization review, auditing, monitoring, credentialing, or quality management experience in MH/SU/I-DD or 3 years with any combination thereof. Must have ability to travel as needed to perform job duties. Basic National Certified Investigator & Inspector Training (NCIT) within twelve (12) months of hire.

Education and Experience Preferred: Master’s Degree with Clinical licensure preferred i.e. LCSW, LMFT, LCAS, LCMHC

Licensure/Certification Required: N/A

Required profile