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Compliance and Performance Improvement Specialist - COMCARE

Date: Jul 14, 2021

Location: Wichita, KS, US

Company: Sedgwick County

Department:  COMCARE 

Pay:  $42,890.00 annually 

Work Schedule: M - F, 8a - 5p 

 

Responsible for executing corporate wide coordination and administration of utilization review and compliance auditing and monitoring related activities as well as tracking and mitigating organizational risks and patient experience concerns.

 

Quality and Risk Management Activities

  • Receive, enter and trend incident reports, follow up as needed and identify areas of risk and/or areas for improvement.
  • Receive, investigate, document, and trend patient complaints.
  • Assists staff in the utilization of Relias learning management system, maintains accuracy of staff hierarchy and assists other human service divisions with uploading training courses. 
  • Participates in Quality, Risk Management and Compliance Oversight Committee.
  • Champion or participate in work groups aimed at improving organizational performance and patient experience of care. 
  • Coordinates agency and medical service patient experience surveys and summarizes responses for Strategy Team.
  • Initiates HIPAA Breach Review forms for committee review.

 

Coordinates utilization and compliance review activities to comply with state and federal mandates

  • Assists the Director of Quality, Risk Management and Compliance with the investigating any reports of fraud, waste or abuse concerning billing or documentation of services.
  • Performs retrospective record reviews and audits with a focus on quality and risk indicators as it relates to utilization of resources, documentation guidelines, contractual obligations, compliance and medical necessity.
  • Generates agency documentation of utilization and compliance review activities which include identified trends, risks, and areas for improvement.

 

Consultation and Education

  • Assists with responding to external auditors and onsite reviewers during site visits.
  • Is available to Directors, supervisors, other COMCARE employees and business partners for review and discussion of regulatory requirements and agency policy. 
  • Identifies and delivers trainings with internal and external customers around service definitions, fraud/waste/abuse and compliance
  • Assists with agency training around a broad range of issues.
  • Completes routine and ad hoc agency reports.

 

Minimum Qualifications: Master’s degree from an accredited college or university in Social Work, Psychology or other Human Service Field.   Demonstrated knowledge of quality improvement principles and regulatory compliance as well as an ability to understand and apply applicable state and federal regulations relevant to mental health, substance abuse, HIPAA and corporate compliance. Demonstrated ability to form quick and lasting relationships and ability to communicate audit findings in ways that others do not feel criticized.  Knowledge and experience with collaborative leadership and working within teams, as well as, across and up/down an organization is required. Three years’ experience in a physical or behavioral health setting with progressive responsibility or any equivalent combination of training and experience which provides the required knowledge, skills and abilities. Must possess a Master’s Degree in a Human Service field and hold respective licensure at the Master level with the State Behavioral Science Regulatory Board.   Must have a valid Kansas Driver’s license and current proof of automobile insurance. Must be able to safely operate a motor vehicle and meet driver qualification standards as set forth in Sedgwick County’s Fleet Vehicle Operation and Usage policy.  Meet the specifications as outlined in the CMHC licensing standards and pass KBI, DCF child abuse check, adult abuse registry, and motor vehicle screens.  Must complete orientations provided by Sedgwick County and COMCARE.

 

It is the policy of Sedgwick County not to discriminate in its programs or services provided to the general public, including employment and all other activities, on the basis of race, color, religion, national origin, citizenship, sex, age, disability, veteran status or any other similarly protected status. Sedgwick County is committed to making the application, interview, and pre-employment testing process accessible to persons with disabilities. If you wish to volunteer information regarding any special assistance you may need, please notify Human Resources by phone at (316) 660-7050, TDD (Kansas Relay at 711 or 800-766-3777). Do not use this phone number for employment questions. This number is provided only for those requiring ADA assistance. You will be contacted should the department feel that you are a qualified candidate.


Nearest Major Market: Wichita

Job Segment: Compliance, Law, Legal