Quality Assurance Manager

Catalight is the parent organization leading a family of companies (FOC) that includes Easterseals Northern California, Easterseals Hawaii, and Catalight Care Services. Across the four non-profit companies, there are nearly 700 employees working together to responsibly disrupt and transform home and community-based care and help become a diverse, equitable and inclusive organization that works proactively to address complex societal problems such as healthcare access and greater well-being for underrepresented communities.

Job Summary

The Quality Assurance Manager is responsible for oversight and management of all internal and external due diligence & quality assurance activities to ensure the Family of Companies'(FoC) and sub-contracted service delivery are conducted in accordance with Company policies and procedures, and in compliance with applicable regional, national, state and federal guidelines. Incumbent will oversee the full quality assurance cycle of Catalight Care Services (CCS) Providers and internal FoC departments, including risk management and control management over operations' effectiveness, financial reliability and compliance with all applicable directives and regulations.

Core Responsibilities & Essential Job Functions

• Coordinate and manage all external due diligence & quality assurance reviews for the FoC including but not limited to claim, chart & program oversight.

• Responsible for performing due diligence of prospective Providers to determine compliance with applicable directives and regulations as well as required internal operating & clinical standards.

• Prepare for and facilitate regular Provider meetings to review quality assurance results with Provider's executive management team and other internal stakeholders.

• Support the development of a comprehensive compliance & quality plan that continuously drives improvements in quality using dashboards and other self-assessment tools.

• Partner with CCS and other internal stakeholders to identify, develop, monitor, and support Providers who are on performance improvement plans.

• Design & disseminate best practices to promote a Quality First culture. Collaborate with the Training Dept as needed.

• Respond to Providers questions/inquiries as they relate to due diligence & quality assurance.

• Continuously look for opportunities to improve existing processes & standard operating procedures.

• Take ownership of & resolve grievances/complaints in a fair & expeditious manner.

• Analyze & trend due diligence & quality assurance results providing reports to internal senior & executive management.

• Engage in continuous knowledge development regarding industry regulations, best practices, tools, techniques, and performance standards.

• Develop and maintain policies, procedures, plans, schedules, and job aids for quality processes and systems.

• Work with Kaiser Permanente, Providers and other staff to resolve any regulatory related issues.

• Support CARF or other similar accreditations.

• Participate in the training of staff and network Providers regarding the directives and regulations.

• Must attend staff meetings, trainings, and other meetings as requested.

• Must adhere to all federal, state & local laws/regulations as applicable as well as HIPAA & Privacy laws.

• Responsible to complete additional job duties as assigned by manager.

Qualifications

Minimum Education, Experience & Training Equivalent to:

• Bachelor's Degree preferred.

• 2 years of Management & Client engagement experience required.

• Proficient in Microsoft Office (Outlook, Word, Excel, etc.) and experience with technology and databases.

• Minimum of 4 years' experience in quality assurance, evaluating compliance, performance management or similar work experience; experience is healthcare setting is preferred

Knowledge & Skills:

• Work experience in behavioral health care quality assurance preferred.

• Work experience managing full due diligence & quality assurance cycles preferred.

• Sensitive to working with an ethnically, linguistically, culturally, and economically diverse population.

• A commitment to the values of the organization while demonstrating good judgment, flexibility, patience and discretion when dealing with sensitive matters and maintaining the highest levels of confidentiality.

• Exceptional people skills are essential. Must interact productively with many different types of personalities and work levels.

• Excellent verbal and written communication skills; frequent proofreading and checking documents for accuracy.

• Displays analytical/critical thinking skills; ability to solve complex problems.

• Excellent computer, analytical and research skills. Proficient on the web and with MS Office applications (Word, Outlook, Excel, PowerPoint).

• Rapid growth and/or not-for-profit experiences a plus.

• Capacity to consistently demonstrate good judgment and decision-making skills.

• Work in an exciting, fast paced high energy environment while effectively multitasking and managing day-to-day responsibilities without supervision; organize and prioritize work and meet critical deadlines.

• Demonstrated experience in chart audits and quality assurance and improvement processes.

• Propensity to demonstrate team processes and facilitate skills.

• Possess the skill set to apply healthcare data analysis to improve processes.

• Provide superior customer service; Excellent client-facing and internal communication skills.

• Expertise to review and comprehend chart audits and quality improvement processes.

• Analyze information and use logic and process to address work-related issues and problems.

• Thrive under deadline-oriented project demands and responsibility of managing multiple initiatives at once.

• Tactfully performs oral presentations.

• Working knowledge of HIPAA privacy and Security rules.

• Personable; able to work comfortably with individuals at all levels within the organization.

• Excellent verbal and writing communication skills; frequent proofreading and checking documents for accuracy.

• Must be highly organized and detail oriented.

• Strong interpersonal skills.

• Familiar with the field of early intervention, ABA, and knowledgeable of other community resources and agencies that serve children.

• Aptness to interpret and implement policies, procedures, and regulations.

• Demonstrated experience with research and information gathering, including the ability to quickly gather data in a short timeframe on a wide variety of topics.

Physical Requirements:

• Ability to communicate effectively within the work environment and to read and write using the primary language within the workplace.

• Ability to complete frequent proofreading and document accuracy checks.

• Comfortable reading large volumes of information on a regular basis.

• Ability to work with clients, staff, and others in the workplace continuously.

• Comfort with frequent speaking and listening (25-75%) to clients, staff, and others in the workplace.

• Ability to utilize computer, cell phone, and virtual meeting software (Zoom, Teams, etc.) for effective communication.

• Frequent sitting.

Conditions of Employment

• Ability to obtain and maintain criminal record clearance through the Department of Justice (DOJ). The People & Performance Department must analyze DOJ/FBI live scan reports in accordance with applicable Federal, State, and Local laws, as well as fitness for the position.

• Ability to obtain and maintain clearance through the Office of Inspector General.

• Must attend any required training.

About Us

At Catalight, we embrace people's differences - both visible and invisible. And we believe everyone deserves to be understood, respected, and celebrated for their many contributions. That's why we have a bold vision to break down barriers and biases to create a more equitable world, so people with developmental disabilities and special needs can choose their own paths.

We do this by providing access to innovative, individualized care services, clinical research, and advocacy - all powered by intelligent Xolv Technology Solutions. And, through the work of our affiliate partners, Easterseals Northern California and Easterseals Hawaii, we provide services to people with disabilities and their families to support them across their care journey.

Our purpose-driven teams are creating a pathway to a more impactful future. Empowering others and fostering an inclusive environment that embodies our core values to ensure we grow responsibly.

Company: Catalight

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Time Type:

Full time

Compensation:

$83,000 - $111,000 Annually

The statements contained in this job description reflect general details as necessary to describe the principal functions of this job. It should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned, including work in other functional areas as deemed fit for the organization.

Catalight is an equal opportunity employer.