DESCRIPTION
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Under general direction, assists the Division Director, Behavioral Health in the development, implementation, and coordination of the Quality Assurance (QA) Division’s administrative initiatives and policies and procedures mandated by federal or state regulations; provides technical assistance and consultation to the Behavioral Health Department leadership, community-based organizations, and contracted providers; performs other duties as required.
DISTINGUISHING FEATURES
The Quality Assurance Supervisor, Behavioral Health is a single position classification located in the Alameda County Health, Behavioral Health Department and reports to the Division Director. This position supports the Division Director, in providing oversight of multiple aligned Quality Assurance administrative functions, including, but not limited to, audits, grievances, appeals resolution, credentialing, waivers, site certifications, and unusual occurrence investigations.
The Quality Assurance Supervisor is distinguished from the Clinical Review Specialist (CRS) Supervisor in that the CRS Supervisor provides day-to-day supervision of operations in behavioral health screenings and referrals, level of care assessments, or clinical direction to other licensed professionals and a large network of independent practitioners and organizations, whereas the Quality Assurance Supervisor, Behavioral Health supervises a work unit with clinical staff that focuses on programmatic responsibilities, including program planning, development, and evaluation, program reporting, and program outcome monitoring.
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EXAMPLES OF DUTIES
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NOTE: The following are typical duties performed by the employee in this classification. The employee may not necessarily perform all duties listed, however, they may perform other related duties at an equivalent level.
- Conducts and/or provides oversight of internal and external audits, investigations, and program reviews to determine potential clinical quality of care issues.
- Analyzes data to identify quality trends across the system; provides recommendations for addressing system issues.
- Coordinates, directs, and effectively supervises quality review activities, which may include unusual occurrences and grievance and appeal processes.
- Continuously evaluates administrative, operational, and programmatic functions of the division and ensures the most effective use of resources; actively identifies opportunities for simplifying and streamlining processes.
- Ensures various policies and procedures are compliant with departmental, federal, and state requirements; provides consultation to department leadership, employees, and contracted agencies regarding state, federal, County of Alameda (County), and departmental policies.
- Participates in strategic planning and task force activities; develops and monitors projects and work plans.
- Stays current with federal and state requirements and Information Notices, leads the division in taking appropriate action and communicating changes; develops effective training programs, and concise, user-friendly, provider notifications and reference documents.
- Takes the lead in studying, interpreting, coordinating, and helping inform implementation of relevant policies that impact Behavioral Health services.
- Supervises administrative and clinical staff; plans, directs, and reviews work; recommends and implements discipline as necessary.
- Leads the QA team in creating and maintaining clear, concise, and accurate Standard Operating Procedure manuals.
- Ensures QA resources published on the website are accurate, professional, up to date, and easy to locate.
- Chairs or effectively participates in departmental, agency and county-wide strategic planning and task force activities.
- Serves as a liaison to internal systems of care, divisions, and programs; effectively coordinates efforts toward agency and departmental goals.
- Consistently demonstrates an understanding of Medi-Cal regulations related to Specialty Mental Health Services and Drug Medi-Cal Organized Delivery System.
- Performs other duties as assigned.
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MINIMUM QUALIFICATIONS
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EITHER I
Experience:
The equivalent of two (2) years of full-time experience in the classification of Clinical Review Specialist in the County of Alameda classified service.
OR II
Education:
Possession of a master’s degree from an accredited college or university in a health care field.
AND
Experience:
The equivalent of three (3) years post graduate level experience in planning, implementing, coordinating, and evaluating Quality Assurance or Quality Management programs in a health care setting.
License:
- A valid clinical license from the applicable licensing authority: California Board of Behavioral Sciences, California Board of Psychology, California Board of Registered Nursing.
- Possession of a valid California Motor Vehicle Operator’s license.
NOTE: The Civil Service Commission may modify the above Minimum Qualifications in the announcement of an examination.
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KNOWLEDGE AND SKILLS
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NOTE: The level and scope of the following knowledge and abilities are related to duties listed under the “Examples of Duties” section of this specification.
Knowledge of:
- General administrative practices and principles; leadership and management skills.
- Principles and practices of program planning and evaluation.
- Practices and techniques of programmatic analysis and report preparation.
- Principles and practices of clinical systems, quality management/improvement/assurance, and risk management principles in a managed care setting.
- Applicable federal, state, county laws, codes, and regulations and their reporting requirements.
- Reimbursement criteria, documentation, and coding requirements for Medicare, Medi-Cal, HMO, PPO, and other common sources of reimbursement.
- Audit protocols for Medi-Cal and Medicare documentation.
- Behavioral health clinical processes and management, public health planning, and quality management in a system of care.
- Quality assessment and measurement principles and techniques.
- Community standards of quality clinical practice, assessment, diagnosis, treatment planning, and documentation.
Ability to:
- Work collaboratively with multi-disciplinary teams, community resources and organizations.
- Organize and prioritize work and meet critical deadlines.
- Interpret, explain, and apply regulations, policies, and procedures.
- Communicate clearly and effectively, both orally and in writing.
- Analyze, evaluate, and make timely, sound decisions.
- Prepare clear, accurate and effective reports, correspondence, and other written materials.
- Establish and maintain effective working relationships.
- Demonstrate interpersonal sensitivity and work with a diverse population.
- Consult, lead, and exhibit team facilitation skills.
- Exhibit flexibility and adapt to frequent changes in regulations and requirements.
- Principles and practices of supervision, work planning, evaluation, and training.
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CLASS SPEC HISTORY
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TE:po 2/7/06
Newspecs: 5081.doc
CSC Date: 3/15/2006
IL:saa Revise/Retitle
Old Title: Quality Assurance Associate Administrator, Behavioral Health Care Services
CSC Date:03/18/26
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BENEFITS
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The County offers a comprehensive and competitive benefits package that affords wide-ranging health care options to meet the different needs of a diverse workforce and their families. We also sponsor many employee discount, fitness and health screening programs focused on overall wellbeing. These benefits include but are not limited to*:
For your Health & Well-Being
- Medical – HMO & PPO Plans
- Dental – HMO & PPO Plans
- Vision or Vision Reimbursement
- Share the Savings
- Basic Life Insurance
- Supplemental Life Insurance (with optional dependent coverage for eligible employees)
- Accidental Death and Dismemberment Insurance
- County Allowance Credit
- Flexible Spending Accounts - Health FSA, Dependent Care and Adoption Assistance
- Short-Term Disability Insurance
- Long-Term Disability Insurance
- Voluntary Benefits - Accident Insurance, Critical Illness, Long-Term Care, Hospital Indemnity and Legal Services
- Employee Assistance Program
For your Financial Future
- Retirement Plan - (Defined Benefit Pension Plan)
- Deferred Compensation Plan (457 Plan or Roth Plan)
For your Work/Life Balance
- 12 paid holidays
- Floating Holidays
- Vacation and sick leave accrual
- Vacation purchase program
- Management Paid Leave**
- Catastrophic Sick Leave
- Pet Insurance
- Commuter Benefits Program
- Guaranteed Ride Home
- Employee Wellness Program (e.g. At Work Fitness, Incentive Based Programs, Gym Membership Discounts)
- Employee Discount Program (e.g. theme parks, cell phone, etc.)
- Child Care Resources
- 1st United Services Credit Union
*Eligibility is determined by Alameda County and offerings may vary by collective bargaining agreement. This provides a summary of the benefits offered and can be subject to change.
**Employees in management-designated classifications may be entitled to management paid leave. Refer to the applicable MOU or Salary Ordinance for more information.
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