Description:
POSITION DESCRIPTION
Position: Quality Improvement & Compliance Specialist (SW)
Department: Quality Improvement & Compliance
Reports To: Chief Quality Officer
Scope:
The Quality Improvement & Compliance Social Worker is responsible for ensuring Healthkeeperz adheres to regulatory standards and continuously enhances the quality of patient care and service delivery. This role involves assessing compliance, developing policies, implementing quality improvement initiatives, and coordinating educational activities, all aimed at improving patient outcomes and supporting the organization's mission and values.
Expectations 1. Review and Analyze
- Conduct thorough audits of case files, member records, and social service practices to ensure compliance with federal, state, and healthcare standards.
- Analyze risk areas, identifying potential gaps or opportunities for quality improvement, and develop targeted action plans to address findings.
- Manage third-party audit requests by coordinating data gathering and ensuring timely, accurate submission.
2. Quality Improvement Implementation
- Design and lead quality improvement initiatives to address deficiencies or opportunities aligned with social work standards and healthcare regulations.
- Conduct patient and caregiver satisfaction assessments to gather feedback for ongoing improvement in care practices and member support.
- Collaborate with the Quality team and other departments to ensure seamless execution of quality initiatives and continuous improvement.
3. Educational Coordination
- Organize and deliver onboarding, annual in-service training, and educational sessions on new regulations, ethical practices, and best practices in social work.
- Present educational content on clinical skills, case management, and compliance with regulatory guidelines, ensuring alignment with organizational standards.
- Monitor staff adherence to updated practices and provide guidance to reinforce compliance.
4. Policy Development and Enforcement
- Develop and update policies related to social work, case management, and compliance, ensuring alignment with federal, state, and industry standards.
- Facilitate access to updated policies and organizational documents via the Intranet to support staff and promote awareness.
- Regularly review policies for compliance with changing regulations and adjust practices accordingly.
5. Documentation and Reporting
- Maintain detailed, organized records of quality improvement activities, compliance checks, and audit findings.
- Prepare reports and summaries for management, offering insights and recommendations to improve service delivery and adherence to compliance.
Results Successful performance in this role will result in Healthkeeperz maintaining high compliance standards, reducing areas of risk, and enhancing the quality of care provided to members. The Quality Improvement & Compliance Social Worker will support Healthkeeperz's vision of cultivating a flourishing culture through exemplary quality practices, ethical service delivery, and an environment focused on continuous improvement.
Knowledge, Skills, Abilities, and Behaviors (KSABs) Knowledge - Comprehensive knowledge of federal and state social work regulations, Medicare/Medicaid guidelines, and healthcare compliance.
- Familiarity with electronic health records (EHR) systems and case management software.
- Understanding of quality improvement methodologies and best practices in patient-centered care.
Skills - Analytical Skills: Ability to review complex case files and data sets, identifying compliance risks and areas for improvement.
- Documentation: Strong skills in record-keeping and report preparation for audit purposes.
- Facilitation: Effective in designing and delivering educational sessions and training for various staff groups.
- Communication: Proficient in both written and oral communication, capable of presenting data, findings, and educational content clearly and concisely.
Abilities - Problem-Solving: Able to assess and respond to compliance risks and quality concerns, using critical thinking to devise effective solutions.
- Time Management: Strong organizational skills with the ability to independently prioritize tasks and manage time effectively.
- Collaboration: Works well within multidisciplinary teams, sharing information and collaborating on quality improvement initiatives.
Behaviors - Detail-Oriented: Maintains a high standard of accuracy in compliance and quality reviews.
- Proactive: Takes initiative to address issues and bring forth recommendations for improvements.
- Ethical Conduct: Models professional ethics and integrity, promoting Healthkeeperz's values and mission.
Requirements:
Requirements
- Education: A Master's degree in Social Work from an accredited program is preferred. Candidates with a Bachelor's degree may also be considered if they have relevant work experience in healthcare quality and compliance.
- Experience: Minimum 5 years of experience in social work or healthcare setting, including case management; Proficiency with Microsoft Office Suite, data collection, and analysis (preferred).
- Certifications: CPR Certification or willingness to obtain within three months of hire. Certification in Healthcare Compliance or related field is preferred.
Physical Demands
The physical requirements for this position align with the essential functions, including driving, standing, walking, sitting for extended periods, and the ability to perform repetitive motions. Some tasks may require occasional lifting/moving of items up to 25 pounds. Reasonable accommodations may be provided for individuals with disabilities.
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