Quality Assurance Specialist - **URGENTLY HIRING**
4 days ago
Springfield Gardens
Job Description:\n\nPOSITION SUMMARY The Quality Assurance Specialist is responsible for assisting in the development, implementation, monitoring, and evaluation of the Agency's Quality Assurance, Regulatory Compliance, Risk Management, and Continuous Quality Improvement programs to ensure services are delivered in accordance with OPWDD regulations, OMIG requirements, Medicaid standards, Agency policies and procedures, and all applicable federal and state regulations. The Quality Assurance Specialist conducts comprehensive audits, compliance reviews, program observations, record reviews, environmental assessments, and regulatory monitoring activities across Residential Services, Certified Day Habilitation, Day Habilitation Without Walls, Community Habilitation, Respite Services, Supported Employment (SEMP), Pre-Vocational Services, Nursing Services, Transportation, Maintenance, Human Resources, Records Management, and other Agency departments to evaluate operational performance, identify areas of regulatory risk, verify compliance, and promote high-quality, person-centered services. The Quality Assurance Specialist collaborates with Executive Leadership, program leadership, clinical departments, and interdisciplinary team members to identify compliance concerns, monitor corrective actions, provide technical assistance, support survey readiness, and promote continuous quality improvement throughout the Agency. The Quality Assurance Specialist conducts internal audits, unannounced program reviews, mock surveys, documentation reviews, environmental inspections, medication observations, active treatment observations, transportation reviews, and other quality monitoring activities to ensure individuals receive safe, effective, person-centered services while assisting departments in maintaining regulatory compliance, improving operational performance, reducing organizational risk, and achieving quality outcomes. REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES Employee must possess the ability to interact professionally and ethically with individuals receiving services, families, Agency leadership, supervisors, managers, Program Coordinators, Residential Managers, clinical professionals, Direct Support Professionals, regulatory agencies, community partners, and interdisciplinary team members while maintaining objectivity, professionalism, and confidentiality. Must possess comprehensive knowledge of OPWDD regulations, OMIG requirements, Medicaid standards, HIPAA, Corporate Compliance, Incident Management requirements, Quality Assurance principles, and all applicable federal and state regulations governing services for individuals with intellectual and developmental disabilities. Must possess knowledge of quality assurance methodologies, regulatory compliance, internal auditing, risk assessment, corrective action planning, root cause analysis, active treatment principles, person-centered planning, documentation standards, incident management, infection prevention, medication administration requirements, fire and life safety standards, emergency preparedness, environmental safety, and continuous quality improvement principles. Knowledge of Life Plans, Staff Action Plans, Behavior Support Plans, Plans of Nursing Services (PONS), PrecisionCare documentation, billing documentation, clinical records, and other OPWDD-required documentation is required. Ability to conduct comprehensive audits, documentation reviews, program observations, interviews, compliance assessments, mock surveys, environmental inspections, medication room reviews, transportation reviews, and regulatory monitoring activities while accurately identifying deficiencies, determining compliance risks, evaluating systemic concerns, and recommending corrective actions. Ability to prepare professional audit reports, exit conference summaries, corrective action recommendations, statistical reports, trend analyses, executive summaries, and other quality assurance documentation using objective, factual, and professional language. Ability to interpret and apply Agency policies, OPWDD regulations, OMIG requirements, Medicaid standards, and regulatory guidance while exercising sound judgment, maintaining confidentiality, prioritizing multiple assignments, meeting strict deadlines, and managing sensitive information. Ability to utilize Microsoft Office applications, PrecisionCare, electronic health records, audit software, databases, reporting systems, and other technology necessary to perform Quality Assurance, regulatory compliance, auditing, and reporting functions. Ability to communicate effectively both verbally and in writing, provide technical assistance and coaching, conduct exit conferences, present audit findings, educate staff regarding regulatory requirements, and establish collaborative working relationships with Agency leadership, program staff, regulatory agencies, and interdisciplinary team members. Ability to travel to all Agency locations, conduct field audits and unannounced program reviews, work flexible hours when necessary to complete evening or weekend observations, and perform duties necessary to support the Agency's Quality Assurance, Risk Management, Regulatory Compliance, and Continuous Quality Improvement programs. ESSENTIAL RESPONSIBILITIES Quality Assurance Program AdministrationWork collaboratively with Executive Leadership, the Director of Quality Assurance, Assistant Director of Quality Assurance, Program Leadership, clinical departments, and interdisciplinary team members to implement, monitor, and continuously improve the Agency's Quality Assurance, Regulatory Compliance, Risk Management, and Continuous Quality Improvement programs.Develop, review, revise, and maintain Quality Assurance audit tools, monitoring instruments, compliance checklists, survey tools, risk assessment tools, and quality review processes to ensure they remain consistent with current OPWDD regulations, OMIG requirements, Medicaid standards, Agency policies, best practices, and all applicable federal and state regulatory requirements.Monitor changes to OPWDD regulations, Administrative Memoranda (ADMs), guidance documents, survey protocols, Medicaid requirements, and Agency policies, and recommend revisions to Quality Assurance monitoring tools, audit instruments, and compliance review processes to maintain regulatory compliance.Assist in the development, implementation, and evaluation of Quality Assurance policies, standard operating procedures, audit methodologies, quality indicators, performance measures, and monitoring systems that promote regulatory compliance and continuous quality improvement.Identify operational, clinical, regulatory, and organizational risks through ongoing monitoring, auditing, data analysis, and program observations and communicate findings and recommendations to Quality Assurance leadership. Compliance Monitoring & Internal AuditsConduct comprehensive internal audits, compliance reviews, and operational assessments of Residential Services, Certified Day Habilitation, Day Habilitation Without Walls, Community Habilitation, Respite Services, Pre-Vocational Services, Supported Employment (SEMP), Nursing Services, Transportation, Maintenance, Records Management, Human Resources, and other Agency departments to evaluate compliance with applicable regulations and Agency standards.Conduct announced and unannounced quality assurance reviews, spot visits, mock surveys, environmental inspections, documentation reviews, and program observations to evaluate regulatory compliance, operational performance, and quality of services.Conduct routine observations of active treatment, person-centered service delivery, staff interactions, community integration activities, transportation services, meal services, medication administration, fire safety procedures, infection prevention practices, and other operational activities to verify services are delivered in accordance with Agency expectations and regulatory requirements.Review Life Plans, Staff Action Plans, Behavior Support Plans, Plans of Nursing Services (PONS), assessments, daily documentation, monthly progress notes, billing documentation, attendance records, PrecisionCare documentation, and other required records to verify accuracy, completeness, consistency, and regulatory compliance.Evaluate programs for compliance with OPWDD regulations, Medicaid requirements, HIPAA, Corporate Compliance standards, Agency policies, and accepted professional standards while identifying deficiencies, compliance risks, systemic concerns, and opportunities for quality improvement. Regulatory Compliance & Documentation ReviewReview individual records, clinical documentation, medical records, Life Plans, Staff Action Plans, Behavior Support Plans (BSPs), Plans of Nursing Services (PONS), assessments, monthly summaries, daily service documentation, billing records, attendance records, PrecisionCare documentation, and other required records to ensure compliance with OPWDD regulations, Medicaid requirements, Agency policies, and documentation standards.Verify documentation is accurate, complete, timely, person-centered, internally consistent, and supports services delivered while identifying deficiencies, omissions, conflicting information, and documentation trends requiring corrective action.Evaluate implementation of Life Plans, Staff Action Plans, Behavior Support Plans, Plans of Nursing Services, safeguards, Levels of Supervision, active treatment requirements, and other individual service plans to ensure services are implemented consistently and in accordance with regulatory requirements and each individual's assessed needs.Conduct documentation reviews to verify required assessments, evaluations, physician orders, nursing documentation, behavior documentation, habilitation records, employment records, community service documentation, and other required records are maintained, current, and compliant with applicable regulations and Agency standards.Monitor compliance with medication administration practices, delegated nursing activities, infection prevention procedures, health and safety requirements, emergency preparedness standards, fire safety regulations, environmental safety standards, transportation requirements, and other operational safeguards through observations, documentation reviews, and quality assurance monitoring activities.Review PrecisionCare documentation, electronic health records, incident documentation, physician orders, appointment tracking, medication records, assessments, alerts, and other electronic documentation to ensure information is accurate, current, complete, and consistent throughout the individual's record.Monitor compliance with incident reporting requirements, abuse prevention procedures, regulatory notifications, investigation recommendations, corrective action implementation, and other Quality Assurance activities while communicating identified concerns to the Director of Quality Assurance and appropriate Agency leadership.Review program operations to verify individuals receive services consistent with approved program descriptions, habilitation objectives, staffing requirements, Levels of Supervision, person-centered practices, active treatment principles, and Agency standards of care. Survey Readiness & Corrective Action MonitoringConduct comprehensive mock surveys, survey readiness reviews, focused compliance reviews, and pre-survey assessments to evaluate program readiness, identify regulatory deficiencies, and prepare departments for OPWDD surveys, certifications, audits, and other regulatory inspections.Prepare professional audit reports, compliance summaries, deficiency reports, exit conference documentation, corrective action recommendations, and quality improvement reports that clearly identify findings, applicable regulations, compliance risks, recommended corrective actions, and opportunities for operational improvement.Conduct exit conferences with Program Leadership and department management to review audit findings, discuss regulatory deficiencies, provide technical assistance, clarify compliance expectations, establish corrective action timelines, and answer questions regarding regulatory requirements and Agency expectations.Monitor corrective action plans to ensure deficiencies are addressed within established timeframes, corrective measures are effectively implemented, supporting documentation is maintained, and corrective actions remain compliant with regulatory and Agency requirements.Conduct follow-up audits, verification reviews, and compliance monitoring activities to validate corrective actions have been successfully implemented, deficiencies have been resolved, and sustained regulatory compliance has been achieved.Identify repeat deficiencies, recurring compliance concerns, ineffective corrective actions, operational trends, and systemic issues requiring additional intervention, and communicate findings and recommendations to the Director of Quality Assurance and Agency leadership.Evaluate audit findings to determine whether deficiencies represent isolated events, repeated occurrences, systemic failures, pervasive compliance concerns, or conditions that create an immediate threat to the health, safety, welfare, rights, dignity, or continuity of services for individuals receiving supports.Escalate significant compliance concerns, high-risk findings, systemic deficiencies, and immediate health and safety concerns to the Director of Quality Assurance while assisting with the development, implementation, monitoring, and verification of corrective action strategies designed to improve regulatory compliance and operational performance. Quality Improvement, Risk Management & Technical AssistanceIdentify operational, clinical, environmental, documentation, and regulatory risks through audits, observations, data analysis, interviews, and compliance reviews, and communicate findings and recommendations to the Director of Quality Assurance and appropriate leadership.Analyze audit findings, incident trends, corrective action outcomes, survey results, and quality indicators to identify recurring deficiencies, systemic concerns, organizational risks, and opportunities for continuous quality improvement.Assist in the development, implementation, monitoring, and evaluation of quality improvement initiatives, performance improvement projects, regulatory compliance strategies, and best practices designed to improve service quality, operational performance, and regulatory compliance.Provide technical assistance, coaching, and regulatory guidance to Program Leadership, supervisors, clinical staff, and Direct Support Professionals regarding OPWDD regulations, Agency policies, documentation standards, person-centered practices, active treatment, and quality assurance expectations.Educate program leadership and staff on identified audit findings, regulatory deficiencies, coEIHAB Human Services is a multilingual, multicultural nonprofit organization dedicated to serving adults with developmental disabilities and behavioral health challenges. We believe every human being deserves the chance to succeed. Through high quality, compassionate care, we aim to help physically, and mentally challenged individuals lead fulfilling, productive lives.
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