Works closely and in conjunction with the Director of Quality Assurance, the Quality Assurance team, the Facilities Risk Manager, Risk Assessment Coordinator, Nursing and Human Resources to assist area offices in maintaining compliance with HCS, TxHmL, DBMD, CLASS, CDS, and ICF-IDD requirements at the local, state, and federal level.
Essential Functions and Responsibilities
- Provides oversight and guidance related to quality assurance duties for assigned areas.
- Provides feedback, guidance, and mentoring for QA Specialists.
- Reviews the Department of Family and Protective Services (DFPS) reports for areas assigned, including DFPS intakes, referrals, extension requests, and investigative findings for assigned areas. Completes or provides oversight for any necessary follow-up related to DFPS reports or required internal investigations.
- Assists in writing formal appeals for DFPS investigations and HHSC appeals or Fair Hearings, as needed.
- Assists in the development, revision, and implementation of Daybreak policies and procedures.
- Assists in the development and training of Support Managers.
- Assists in the development and training of Area Directors.
- Assists in the development and training of Residential Managers and other Daybreak personnel as required.
- Assists in the revision and implementation of training manuals developed through the Quality Assurance Department.
- Completes an extensive documentation review and provides written reports for Daybreak cases involving unusual incidents or death.
- Provides review and feedback of the chart reviews which have been completed by his or her assigned Quality Assurance Specialists. Completes a second review of any charts scoring below the required percentage.
- Reviews and audits HCS, TxHmL, CLASS, DBMD, CDS, and ICF-IDD documentation for assigned areas.
- Performs internal billing audits for area offices, applying knowledge of HCS, TxHmL and other required Texas Administrative Code (TAC) Billing Guidelines.
- Assists area offices in preparing for annual/intermittent surveys and billing audits, as necessary.
- Works in conjunction with Director of Quality Assurance to review and verify information related to potential Level of Need (LON) increases and packets. Assists in the oversight and organization of LON packets to be sent to HHSC Utilization Review department.
- Assists in the completion and/or tracking and trending of various Quality Assurance tasks, such as Satisfaction Survey processes, Annual Identified Vendors, Individual Exit Questionnaires, and other tasks as assigned.
- Provides technical assistance to area office team members, as well as members of the support center.
- Proficient in the use of computer applications such as Microsoft Word, Excel, Outlook, and Access database, as well as state databases such as CARE and other software as necessary.
- Acts as a member of the Special Review Committee.
- Attends training deemed necessary for improving knowledge in the field of developmental disabilities.
- Available during normal business hours of 8am – 5pm, Monday-Friday, and as needed during non-regular work hours, including after-hours or weekends.
- Compile Critical and Non-critical Incident Injury Analysis reports each quarter for HCS QAC Meetings.
- Complete the Annual Executive Committee Meeting report for April HCS QAC Meetings.
- Complete tasks for EVV (electronic verification visits) for HSC and DBMD PAS HAB, in home respite and in home day hab. Tasks include EVV training, tracking and auditing.
- Review and approve IBAMs daily for assigned regions.
- On-site representation for HCS and ICF Surveys as appropriate.
- Assists in writing Plans of Correction in ICF and Corrective Action Plans in HCS.
- All other duties as assigned by management.
- Must possess knowledge of HHSC HCS, TxHmL, ICF-ID, DBMD, and CDS Texas Administrative Codes (TACs) and Billing Guidelines and their application.
- Knowledge of DFPS abuse, neglect, and exploitation rules, reporting, follow-up, and documentation.
- Knowledge of the Level of Need (LON) process in relation to ID/RCs, ICAPs, and LON increase requests.
- Excellent writing skills.
- Outstanding communication skills.
- Outstanding organizational skills.
- Proficient in computer applications such as Microsoft Word, Excel, Outlook, and Access database.
- Bachelor’s degree in social, behavioral, human services, or related fields or equivalent experience in the field of IDD services.
- Must have at least 2 years’ experience working with/serving persons with developmental disabilities in HCS and ICF fields.
Ability to read and comprehend instructions, manuals, and other company documents. Exhibits excellent oral, written communication and customer service skills.
Understands the concept of addition, subtraction, multiplication and division.
Ability to apply common sense understanding to carry out detailed written or oral communications or instructions. Ability to deal with problems involving unconventional variables in unusual situations.
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Duties of this job are performing the following:
- 40% – 50% travel (includes overnight travel)
- Sitting – 50% of work time
- Standing – 50% of work time
- Walking – 40% of work time
- Bending, pushing, pulling, stooping, reaching, kneeling – 25% of work time
- Grasping and finger/hand manipulation – 50% of work time
- Ability to lift up to 75 pounds
- Ability to operate computer, facsimile, copier, shredder, calculator
- Safety hazards may exist if equipment is not used properly, if proper techniques/equipment is not used when lifting, if vehicles are not operated safely, or if proper behavior intervention techniques are not utilized.
- An office setting, varying degrees of background noise, standard office ventilation and lighting, occasional temperature fluctuations are found in the work environment.
- In a vehicle, subject to outside temperature changes and weather.
- Facilities are smoke-free; smoking areas are designated.
- Work in assigned office setting at support center, as well as a variety of office settings in area offices. (office settings, moderate background noise, standard office lighting, occasional temperature fluctuations)
- Normal business hours with the flexibility to work overtime or non-standard hours as required by the job.
Travel of 40% – 50% via car or airplane to area offices.