VICE PRESIDENT OF QUALITY IMPROVEMENT AND MON
ESSENTIAL FUNCTIONS:
The Director of Quality Improvement and Monitoring is responsible for performing necessary monitoring and oversight functions as an intra-agency liaison between clinical program services and administration. Provides programmatic technical assistance and training to ensure compliance with MRO certification and licensing rules and regulations. The Vice President of Quality Improvement and Monitoring will actively assist in identifying and preparing operational goals and objectives associated with the MRO and Managed Care (MCO) service authorization, implementation and billing processes and maintain accountability for the design as it relates to the funding sources, licensing, and certification requirements. Provides direct support to the acquisition of agreements with HMOs and private insurance companies and ensures conformance with requirements for third party billing. Provides programmatic technical assistance and training to staff on “fee for service, clinical documentation and other requirements for certification and licensure. Also, serves as liaison and coordination of all IHPA activities. The position reports directly to the Chief Executive Officer.
POSITION RESPONSIBILITIES:
• Serves as principal supervisor of the MSW Student Intern Program, providing recruitment, selection, onboarding, training and weekly supervision of interns. Serves as primary liaison with schools and ensures completion of agency requirements for students.
• Conducts regular internal audits and reviews to monitor compliance with applicable City, State, Federal, accreditation and other relevant requirements and standards. This includes driving the client record peer review process, as well as conducting random and planned visits to agency sites.
• Coordinates the preparation for program audits and reviews, develops corrective action plans and coordinates implementation of corrective action plans.
• Provides clinical support to DD, MH and SUD teams as needed.
• Works directly with program supervisors to monitor and evaluate mental health assessments and client treatment plans for content, and to ensure that the services identified that are connected to a billable service are documented appropriately in progress notes, and are billed on a consistent basis, following related guidelines and procedures.
• Provides feedback to Administration and consults directly with the Chief Operating Officer on the implementation of plans of correction of client records and documentation into MRO/MCO compliance and/or to address under-reporting of revenue projections.
• Conducts group consultation monthly to address areas of service and/or billing that are identified as needing improvement.
• Provide feedback on individual performance issues and strengths of the clinical staff to the respective managers at least twice a year in conjunction with performance evaluations.
• Develops, facilitates and/or provides clinical training based on identified needs.
• Regularly reviews program policies and procedures and assists department directors with annual updates.
• Provides a written report of activities, as well as progress on outstanding plans of improvement, to the executive team at least monthly.
QUALIFICATIONS:
Must possess the following:
Master’s degree in social work, public health, or a related human services field.
At least ten (10) years of professional experience in Human Services, with at least five (5) of those years providing administrative, quality improvement and/or related program supervision and/or 5 + years managing a compliance program.
Experience in medical records and billing is preferred.
Professional clinical license (LCSW, LCPC, LMFT, Psychologist) is preferred.
Some familiarity with federal/state/local, DHS, SUPR, Medicaid and 3rd Party insurers’ guidelines and certification standards. Key knowledge of Affordable Care Act, IL Department of Healthcare and Family Services mandates and provisions for relevant entities (e.g., Care Coordination Entities), Third Party billing procedures with key MCOs (e.g., Illini, BC/BS, etc.). Solid experience in managed care and government programs.
Some experience working with state level regulators.
Strong project management skills and experience.
Excellent communication skills (verbal and written) and experience in developing and conducting training.
Must have intermediate working knowledge and skill in Microsoft Word, Excel, and PowerPoint.
Must have intermediate working knowledge and skill with an electronic health records system.