Under general supervision, reviews, monitors and evaluates program areas within the Department of Health and Social Services with a goal of regulatory compliance and continuous quality improvement.; performs lead duties over the Compliance and Quality Assurance Analysts; serves as the Deputy Privacy Officer; and plans, implements, conducts, maintains and evaluates training and communication programs to ensure all employees are educated about the compliance program, Code of Conduct, policies and procedures, and other specific compliance issues.
This class is distinguished from the:
·Compliance and Quality Assurance Manager class which serves as chief of the Quality Management and Compliance Division and plans, directs, supervises and coordinates the activities and operations of the division; the manager serves as the Chief Privacy Officer for the Department of Health and Social Services and ensures that the Department’s business and provider practices are compliant with Federal, state and local regulations and requirements; identifies and assesses areas of compliance risk and prepares recommendations that reduce those risks; coordinates assigned activities with other divisions, departments, and outside agencies; and serves as a member and integral part of the Department’s senior management team.
·Compliance and Quality Assurance Analyst class which conducts compliance reviews and quality assurance studies which are less complex due to the smaller size of the workforce engaged in the program, the limited number of funding sources, the size, demographics or program requirements of the client base of the program, and/or the standard nature of the Federal and state laws and regulations governing the program.
Supervision Received and Exercised
Supervision is provided by the Compliance and Quality Assurance Manager.
No supervision is exercised over others, however the incumbent in this class performs lead duties over employees in the class of Compliance and Quality Assurance Analyst.
·Conducts compliance reviews which are complex due to the large size of the workforce engaged in the program, the complexity of the funding sources, the size, demographics and/or program requirements of the client base of the program, and/or the number and complexity and changing nature of Federal and state laws and regulations governing the program; conducts these complex compliance reviews in accordance with state issued guidelines and internal policies and procedures; reviews documentation to determine compliance with funding sources, criteria, agency policies and procedures, and state and Federal guidelines; conducts reviews of contracts and grants which are complex due to their size, program attributes, and/or funding sources to ensure regulatory and fiscal compliance with Federal and state laws; identifies problems/issues or potential problem areas needing corrective action; coordinates findings, issues and recommendations with fiscal oversight staff as well as impacted program staff; develops and issues written narrative and statistical reports; in conjunction with program staff, develops and/or revises procedures and operational guidelines;
·Performs the following duties as Deputy Privacy Officer: develops compliance measurement systems designed to evaluate individual progress and/or program effectiveness; conducts and/or coordinates investigations of alleged violations of the compliance-related laws and/or the Code of Conduct and makes recommendations for corrective actions; and recommends revisions to the compliance program and the Code of Conduct.
·Plans, implements, conducts, maintains and evaluates training and communication programs to ensure that all employees are educated about the compliance program, Code of Conduct, policies and procedures, and other specific compliance issues.
·Serves as lead over quality assurance reviews to monitor and evaluate the quality and appropriateness of various service programs; develops and recommends new/revised procedures and/or corrective action plans to resolve service and system issues, to improve customer care systems and to optimize the utilization of resources; meets with employees, supervisors, managers, contractors, service providers, clients, etc. to identify strengths/weaknesses of the organization and consumer satisfaction with services; develops and issues written narrative and statistical quality management reports which includes strategies to meet identified goals and measurement systems to track progress in achieving the stated goals; in conjunction with program staff, develops and/or revises procedures and operational guidelines;
·Serves as a liaison to departments in other counties and to other state and Federal agencies regarding compliance review and quality management activities; attends training, conferences and meetings of regional and state-wide groups that focus on compliance and quality improvement issues; provides technical assistance and support to department supervisors and staff; and participates in staff meetings to discuss, provide information, and elicit support regarding improving regulatory compliance and quality of service.
·Performs lead worker duties over employees in the class of Compliance and Quality Assurance Analyst such as:
•providing on-the-job training;
•passing on instructions received from supervisor and getting work started;
•monitoring status of work being performed and keeping supervisor informed of work progress and likelihood of meeting timelines and required deadlines;
•reviewing work, informing supervisor of customer feedback, work quality, conduct problems, etc. and providing input on performance to supervisor;
•ensuring accuracy and timeliness of timesheets and monitoring leave schedules;
•resolving informal employee complaints; and
•ensuring work is performed safely and efficiently.
·Performs other duties of a similar nature or level as assigned.
Knowledge, Skills & Abilities
·Standard and accepted principles of leadership, on-the-job training, and work review.
·Federal and state laws and regulations applicable to the conduct of compliance and quality assurance reviews such as: Health Insurance Portability and Accountability Act (HIPAA), Mental Health, Medicare and Medi-Cal requirements, CalWorks/FoodStamps/CalWIN programs including quality assurance standards; In Home Support Services; and False Claims and Anti-Kickback statutes.
·Health care and social service programs provided by the counties in the state of California.
·Funding sources for department programs and services.
·Practices and procedures related to conducting program research and statistical reviews.
·Practices and procedures related to continuous quality improvement.
·Principles and techniques of developing and implementing training programs.
·Oral communication techniques to include presentations to groups of various sizes in a positive, inclusive, and motivational manner.
·Customer service techniques for dealing with customers, often in a difficult or confrontational situation.
·English composition, spelling, grammar, vocabulary, and punctuation for both written and oral communications.
·Formats and appropriate terminology for written communications such as business correspondence, policies, procedures and statistical and narrative reports.
·Standard office procedures, practices, equipment, personal computers, and software.
Skill and/or Ability to:
·Provide work directions, review work performance and conduct of staff, and provide on-the-job training to staff led.
·Research laws, regulations, procedures and/or technical reference materials; analyze, evaluate and interpret the data gathered; draw logical conclusions; develop reasonable and deliverable options, make appropriate recommendations; and implement the resultant change effectively.
·Collect, review, and compile data to establish/identify compliance and/or quality management issues.
·Evaluate program activities, participate in root-cause analysis, problem resolution, or other corrective actions, and recommend policy and program changes.
·Develop and provide effective training to staff on complex regulatory requirements.
·Manage a variety of simultaneous work projects and carry them through to successful completion.
·Determine the appropriate course of action and demonstrate personal diplomacy in difficult and/or stressful situations.
·Communicate information and ideas clearly and concisely, both orally and in writing.
·Work with and speak to various cultural and ethnic individuals and groups in a tactful and effective manner.
·Establish and maintain effective working relationships with those contacted in the performance of required duties.
·Represent the office in meetings with representatives from various County and non-County organizations, with local businesses, with customers, and/or with the general public.
·Prepare a variety of written communications to include narrative and statistical reports, policies and procedures.
·Maintain accurate records and document actions taken.
·Maintain confidentiality of records and information per pertinent laws/regulations.
·Use modern office equipment to include computers and related software applications.
Education and Experience
Education: Bachelor’s degree or higher from an accredited college or university with a major in Accounting, Business Administration, Finance, Health Administration, Public Administration, Social Work, or a closely related field.
Experience: Four years of full-time professional program experience in a quality management, planning and evaluation, quality improvement, or closely related field.
·Applicants are required to possess a valid California Driver’s License, Class C.
·Employees are required to obtain a Healthcare Compliance Certificate from the Health Care Compliance Certification Board within one year of appointment.
·Possession of one of the following valid licenses issued by the State of California may be considered during the rating and/or selection process: Physician; Licensed Psychologist; Licensed Clinical Social Worker; Licensed Marriage, Family and Child Counselor; or Registered Nurse.
·All licenses, certificates and registrations must be kept current while employed in this class.
PHYSICAL REQUIREMENTS :
·Mobility and Dexterity: Employees in this class will be stooping, kneeling, reaching, standing, walking, fingering, grasping, feeling (i.e. sense of touch), and performing repetitive motions.
·Lifting, Carrying, Pushing and Pulling -- Light Work: Employees in this class will be exerting up to 20 pounds of force occasionally and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects.
·Vision: Employees in this class will need to have close visual acuity, with or without correction, to prepare and analyze data and figures, transcribe, view a computer terminal, read, etc. Employees in this class are also required to have depth perception in order to operate a motor vehicle.
·Hearing/Talking: Employees in this class will be required to perceive the nature of sounds at normal speaking levels with or without correction, and have the ability to receive detailed information through oral communication. Positions in this class require the employee to express or exchange ideas by means of the spoken word.
·Office Work: Employees in this class will most often be working in an office setting.
·Work in a Medical Clinic Facility: Employees in this class may occasionally be working at a medical clinic facility and thus will be subject to exposure to chemicals, toxic agents, blood and other bodily fluids, and communicable diseases.
·Traffic Hazards: Employees in this class will be required to operate a vehicle and thus will be subject to traffic hazards while driving.
·Disruptive/Confrontational Human Contacts: Employees in this class may be subject to disruptive and confrontational people.
· Working Alone: Employees in this class may be working at night and/or on weekends, and thus may working alone for extended periods of time.
·Background Checks: The County may conduct a background check and a reference check on candidates prior to appointment to a position within this class.
·Independent Travel: Employees in this class are required to travel independently, for example, to perform work at other work sites, to attend meetings with other County employees, to attend meetings with community organizations, etc.
·Hours of Work: Employees in this class may be required to work weekends, holidays, irregular hours, on-call, and after normal business hours.