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Quality Assistant – Non Profit, Care Management (SW, RN)

Full Time
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Job Description

Under the supervision of the CMD Director with oversight by the Quality and Training Coordinator, the Quality Assistant will work to ensure that The Information Center is providing quality service and maintaining quality goals to MI Choice Medicaid Waiver Participants.

Job Responsibilities

  • Review individual case records for appropriate standards and/or errors related to the following:
    • professional documentation
    • appropriate care planning
    • monthly communication
    • appropriate care setting changes
    • timely reassessments
    • Any factors related to specific items found in the MI Department of Health and Human Services (MDHHS) Clinical Quality Assurance Review (CQAR).
  • Work with Quality and Training Coordinator to prepare and respond to CQAR Audit.
  • Work with the Care Management Department with preparations for NCQA re-accreditation.
  • Work with the Quality and Training Coordinator, and Care Management Department Supervisor(s) to successfully pass the annual MDHHS program reviews.
  • Work with the Quality and Training Coordinator to complete Nursing Facility Level of Care (NFLOCD) reviews.
  • Maintain the NFLOCD chart file and upload to electronic clinical charts once the Freedom of Choice is signed by Participant/Representative.
  • Maintain the Adverse Benefit Determination File. Ensure that the documents were successfully uploaded to the electronic clinical chart.
  • Ensure that Nursing Notes, Counseling Notes, and Resident Care Agreements are received as required by MDHHS/MI Choice Medicaid Waiver Contract Guidelines. Maintain a spreadsheet for each area and provide to Quality and Training Coordinator monthly.
  • Provide to the Primary Supports Coordinator. Ensure that appropriate follow up is completed if required.
  • Participant in monthly quality meeting to discuss ongoing department-wide quality measures and outcomes as they relate to the agency’s ongoing Quality Management Plan.
  • Attend the Statewide Quality Management Collaborative Meetings and any other meetings as required.
  • Develop and conduct Consumer Advisory Council Meetings (Local QMC group). Work with Administrative Staff to increase Participant/Representative attendance.
  • Manage the Agent Provider List in Compass utilizing Formstack. Enter Arranged Services in the Agent Provider List and confirming information is accurate.
  • This position is responsible to act as a confidential representative of the Agency.
  • Complete other duties as assigned.

Required Knowledge & Skills

  • Ability to communicate effectively within in the various agency departments.
  • Ability to review and analyze records.
  • Ability to utilize critical thinking skills
  • Working knowledge of community-based resources for individuals with disabilities and/or the elderly
  • Working knowledge of benefits provided by Medicaid, Medicare and/or other third party payers.
  • Ability to analyze policy material.
  • Possess a current valid Michigan driver’s license, proof of adequate insurance and transportation for home visits, is required.

Education & Experience

  • Bachelor’s degree, Preferably in Nursing, Social Work, Business Administration, (or other business related field), or Quality Assurance.
  • If degree is in Nursing (RN or LPN) or Social Work, must be licensed in the State of Michigan (LLBSW, LBSW, LLMSW or LMSW).
  • Prefer two years’ experience in a hospital, home care, or community based setting.

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