YCOT QM/UM Support Staff - Denton - Denton County MHMR

Description

YCOT QM/UM Support Staff
Under the direction of the Program Manager of Youth Crisis Outreach Team (YCOT) and within federal, state and local guidelines performs complex human services support work. Work involves conducting inspections and quality assurance reviews to ensure compliance with laws, regulations, and agency policies.
The Crisis Auditor is responsible for monitoring and conducting activities under the supervision of the Program Manager of YCOT. The position is responsible for the implementation of an on-going quality assurance program designed to objectively and systematically monitor and evaluate the quality and appropriateness of crisis services, pursue opportunities to improve consumer care and resolve problems. This position will be directly responsible for carrying out quality improvement processes and strategies focusing on crisis and YCOT services and producing reports associated with quality assurance monitoring. Works under moderate supervision, with limited latitude for the use of initiative and independent judgment. This is a grant funded position and continued employment is contingent upon the availability and renewal of grant funding. The current grant period runs through 2030.
Education, Training, and Experience

• High School Diploma, or GED is required.
• Three years quality assurance experience in the HHSC service system preferred.
• Working knowledge and ability with Windows based Microsoft Office Word, Excel, Access software, E-mail and internet use or knowledge required.

Registration, Certification, Licensure, and Other Qualifications

• All Job specific training must be completed within 30 days of hire.
• Must maintain a valid Texas driver's license, auto liability insurance and a driving record acceptable to the Centers insurance requirements.

Knowledge, Skills and Abilities
Knowledge of Texas Laws, codes, and standards related to the area of responsibility, of the principles and methods of field inspection and quality control and of business practices.
Skills in conducting inspections, in determining proper courses of action, in using instruments and tools necessary to conduct inspections; in using computer-based programs and databases, and in maintaining records and written reports.
Ability to learn and navigate the Center's electronic health record.
Ability to read and interpret grant paperwork and the statement of work to ensure compliance with reporting measures and submission deadlines.
Ability to prepare reports, to interpret laws and regulations, to gather and analyze data, and to communicate effectively verbally and in written form.
Understanding and practice of Trauma Informed Care principles.
Essential Duties
1. Monitors and analyzes utilization management/resiliency, disease management, and crisis services data.
o Specific area of focus will be the YCOT program.
o Additional programs will be audited upon request.
2. Develops quality indicators for review of each crisis services program service area; conducts reviews on an ongoing basis to assure assessment of current, applicable crisis services quality indicators.
3. Ensures that YCOT receives at least an annual program review.

• Develops an annual review schedule.

• Conducts reviews according to schedule.

• Provides two-week written notification to program prior to review.

• Produces written program summary within 10 working days of review and submit to supervisor.

• Reviews will be more frequent during the implementation phase and upon request.
4. Reviews crisis services incident, medication error and safety reports.
5. Facilitates crisis services data collection and trending reports.
6. Attends the Centers Safety committee as the YCOT representative; ensures adherence to the Center's ADA related activities.
7. Completes crisis services medical record reviews as required for center self-assessment activities; compiles deficiency reports and forwards to service provider about non-compliant findings; enters results into a historical worksheet to track trends, making reports available as needed.
8. Performs trend analysis on ongoing crisis services quality review findings and submits trend reports to supervisor as required; completes assigned crisis services quality of care investigations; completes assigned crisis services focused reviews; completes Center's Death Reviews as assigned.
9. Attends utilization management committee meetings as scheduled.
10. Conducts utilization reviews or care reviews as assigned to determine appropriateness of eligibility determinations; use of exceptions and overrides to service authorizations, over and underutilization.
11. Assists with monitoring the centers' appeals and denials process; assists with monitoring fairness, equity and cost effectiveness of all services provided.
12. Ensures the provision of and adherence to Center related abuse, neglect, rights, program complaints & related investigative processes.
13. Provides back up to the MH or IDD Rights Protection Officer as needed; serves as back up liaison to the Texas Department of Family and Protective Services (DFPS) as needed.
14. Ensures the provision and adherence to the Center's appeals and Medicaid Fair Hearings process as required; conducts all assigned investigative processes according to center policy, procedure and related rules; completes and processes all related documentation within two business days of receipt.
15. Ensures current postings of all applicable related information at each Center operated/contracted facility or residential programs as required.
16. Attends and advocates as appropriate and requested on behalf of a person served within established rules and regulations.
17. Ensures YCOT vehicles are maintained by performing monthly checks on vehicle inventory.
o All necessary postings must be maintained in YCOT mobile service vans.
18. Provides abuse, neglect, rights and confidentiality (ANRC) training as scheduled
19. Coordinates internal crisis services satisfaction surveys in accordance with applicable rules and regulations, performance contracts and the center's current policies and procedures; compiles all results in a historical worksheet to track trends and make reports available to supervisor on an annual basis and as needed.
20. Conducts follow-up surveys with consumers to ascertain outcome achievement and satisfaction as part of the quality.