Quality Assurance Manager- ECM (Los Angeles)
3316 S. Main St. Los Angeles, CA. 90007
RICMS - ECM (LA) – Quality Assurance Manager /
Full-Time /
On-site
Amity Foundation, an internationally acclaimed Teaching, and Therapeutic Community is seeking compassionate and enthusiastic individuals with a desire to teach, learn and join our community as a ECM Quality Assurance Manager. This groundbreaking opportunity will allow you to work with our prison and re-entry programs helping the community and will also enhance your training and experience in the field.
About Amity:
Amity Foundation is a safe place where people can change in an environment that fosters trust; where new values can be formed; responsibility developed, and lasting relationships built. Amity is dedicated to the inclusion and habilitation of people marginalized by addiction, homelessness, trauma, criminality, incarceration, poverty, racism, sexism, and violence. Amity is committed to research, development implementation, and dissemination of information regarding community building.
Remembrance, Resolution, Reconciliation, Restoration, Renewal
About the Position:
The Quality Assurance (QA) Manager for the Enhanced Care Management (ECM)-Community Supports (CS) program is responsible for the compliance of this project. ECM is a comprehensive, patient-centered approach to healthcare that aims to improve outcomes for high-need populations. This involves the coordination of medical, behavioral, and social services to address the full range of patient needs, focusing on those with complex and chronic conditions. ECM programs are designed to optimize care delivery, reduce unnecessary hospitalizations, and improve the overall quality of life for students. The Quality Assurance (QA) Manager supervises QA staff and supports the mental health staff involved in maintaining both paper and Electronic Health Record (EHR) documents and files for Students, including compliance, Medi-Cal billing, and contract oversight at one or More Managed Care Plans (MCP). The QA Manager reports to the Program Director.
What You Will Do:
- Responsible for providing supervision and training to the Quality Assurance Specialist(s)
- Responsible for overseeing all billing system entries for assigned programs in coordination with program QA staff
- Monitor Medi-Cal, MCP contract-specific documentation of ECM Direct Service Staff.
- Distribute necessary information to various departments within the agency as well as outside agencies.
- Collaborate with the accounting department regarding billing and invoicing systems.
- Liaison with various county personnel to ensure ongoing collaboration, address concerns, and rectify any issues.
- Liaison with LCM care team, MCP, and ECM Management team to ensure that both the needs of the program and the needs of QA are being met in a timely manner.
- Develop policies and procedures as appropriate for the role.
- Oversee Internal Audits of each program to assess for Medi-Cal, contract, and agency compliance.
- Participate in the development of training focusing on documentation and compliance.
- Oversee QA development within new programs created within the agency
- Ensure programmatic understanding of contracts and serve as the primary point person for all contract compliance issues.
- Conducts annual Quality Assurance Program Element review. Consistent member of the Quality Assurance Team.
- Attends all integrated monitoring by the Amity Foundation Quality Assurance Team and licensing agencies.
- conducts internal monitoring, auditing, and periodic risk assessments at each county ECM site to ensure all employees are trained and compliant with licensing and state regulations.
- Identifies potential areas of compliance vulnerability and risk; develops corrective action plans.
- Conducts timely reviews of Each Managed care plan policy, procedure, and Medi-Cal information is up to ensure up to date.
- Completes required reports and documentation in a timely manner, provides management with required reports, and advises of any problematic situations.
- Ensures the highest standards are maintained to prevent illegal, unethical, or improper conduct and to ensure the program remains in compliance with The Health Insurance Portability and Accountability Act (HIPAA) and Protected Health Information (PHI) and in accordance with state licensing regulations.
- Assists with the correction of deficiencies and quality improvement efforts.
- Commits to attending all training and staff development classes in order to ensure sufficient hours of training on an annual basis. Notifies supervisor if annual training hours are deficient.
- Ensures the safety, health, and welfare of staff and students at all times.
- Models and ensures all program norms are upheld without compromise.
What You Will Bring:
- Excellent interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in the community and within the organization.
- Knowledge of contract parameters, objectives, milestones, and other deliverables.
- Knowledge of contracting process and associated local, state, federal, and other regulations.
- Ability to integrate budgetary and service utilization data, forecast expenditures, and respond to ensure both effective provider utilization and budget compliance.
- Ability to multitask, identify problems, provide recommendations to management teams, and implement any applicable systems.
- Ability to work constructively with diverse people and with parties that may have divergent perspectives and interests.
- Ability to clearly express concepts and direction, both orally and in writing, and to prepare complex reports, policies, and procedures.
- Understand and appropriately apply Amity policies and procedures and adhere to agency-wide practices and regulations.
- Strong oral and written communication skills.
- Proficient with software such as Microsoft Office Suite (Word, Excel. Email, Internet, etc.).
- Ability to utilize resources available to complete assigned projects.
- Ability to prepare written reports and correspondence.
- Ability to effectively communicate, verbally and in writing.
- Able to work in excess of 40 hours per week with the possibility of a varied schedule
- Must be able to maintain a high level of confidentiality.
- Ability to build and maintain positive internal and external relationships.
- Ability to provide exemplary customer service to all employees and outside constituents.
- Ability to function independently and as a member of a team in a multi-task environment.
- Must be flexible and able to handle multiple priorities, with the ability to adjust to high pressure and rapidly changing business conditions.
- Education and Experience:
- Required:
- (EHR) and Preferred: Masters level degree, preferably in Social Services or related field, Minimum Bachelor's level degree, preferably in Social Services or related field.
- High level of organizational and analytical skills.
- Ability to understand or learn Medi-Cal regulations and principles.
- Basic understanding of Title 22 principles.
- Must meet the requirements to be an eligible Amity Foundation driver. Must possess a current State Driver’s License and have an acceptable driving record for the past three (3) years.
- Excellent attention to detail and the ability to manage complex information with high accuracy.
- Strong organizational and time-management skills.
- Proficiency with data entry, electronic health record systems, and Microsoft Office suite.
- Effective written and verbal communication skills.
- Experience with managing reports and reviewing services prior to claim submission in a behavioral healthcare setting is a plus.
- Certifications or Licenses:
- Required: NONE.
- Driver’s License
What We Bring:
- Medical, Dental, Vision.
- Paid vacation, sick time, & holidays.
- 401K, HSA, & Life insurance programs.
- Organization committed to community action.
- Community oriented workplace.
$75,000 - $75,000 semi monthly
