County of Alameda

DESCRIPTION

Under general direction, develops, implements, coordinates and facilitates the Quality Assurance, Management and Improvement Programs for the Alameda County Behavioral Health Care Services (ACBHCS) and the department’s Managed Care Plan.

DISTINGUISHING FEATURES

This is a single class position located in the Behavioral Health Care Services Department in the Health Care Services Agency. The position is responsible for all aspects of planning, developing and evaluating the department’s quality management and quality improvement programs. It also has responsibilities for developing and implementing policies and procedures for the Consumer Assistance service delivery. It is distinguished by the full range of administrative, clinical, credentialing and supervisory responsibilities for the Mental Health Managed Care Plan administered by the Behavioral Health Care Services Department. The position reports to the Quality Management Program Director.

EXAMPLES OF DUTIES

NOTE: The following are duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Each individual in the classification does not necessarily perform all duties listed.

1. Plans, develops and evaluates the effectiveness of Quality Management and Improvement Programs for ACBHCS and its managed care plan; implements new programs/systems or updates existing programs/systems to deliver services and improve operational procedures and productivity following modern managerial approaches and profiles; collaborates with other administrative staff in planning activities with the goal of ensuring ongoing effectiveness and provision of quality services.

2. Provides a comprehensive plan to identify and take corrective action to eliminate potential risks for ACBHCS’s clients; develops operating policies and procedures as necessary in accordance with specific objectives of the various programs administered by ACBHCS; investigates, evaluates and recommends system changes as necessary.

3. Develops and updates QA/QM/QI policies and procedures for the ACBHCS and its managed care plan; interprets and implements CA State Alcohol and Drug Programs and Department of Mental Health, Title IX, and other State and Federal regulations (Medicare) pertaining to QA/QM/QI practices; ensures compliance with all related state, federal and local regulatory agencies and established ACBHCS and its managed care plans standards, practices and procedures; coordinates plan of corrections and monitoring methodologies when necessary.

4. Chairs the ACBHCS-MH Credentialing Committee and ensures that providers have appropriate education, training, licensure, pertinent credentials, malpractice insurance, and other specialized certifications as indicated; reviews provider applications to determine eligibility for admission into the ACBHCS-MP provider network; facilitates level I appeal hearings for provider applicants where there is an intent to deny membership within the ACBHCS-MHP network.

5. Chairs the Quality Assurance Committee, coordinates the collection of monitoring data, assessment and measure of organizational performance; analyzes and reports aggregate data with recommendations to the ACBHCS’s Administrative team.

6. Chairs the ACBHCS Centralized Utilization Review Committee, coordinates, directs and monitors all related aspects of the utilization control program; orients new organizational providers to the UR system; facilitates UR training.

7. Manages the Quality Assurance and Consumer Assistance Offices; supervises the Consumer Assistance Specialist; develops and implements policies and procedures for beneficiary complaints and grievances in accordance with CA State ADP and DMH regulations.

8. Organizes and conducts onsite QA audits in accordance with standards and protocol; prepares audit reports with recommendations to administration; organizes Medi-Cal certification onsite reviews.

9. Coordinates continuing education programs for clinical psychologists, marriage, family and child counselors, licensed clinical social workers, and registered nurses.

10. Develops and maintains the ACBHCS’s QA Manual in accordance with ACBHCS and regulatory agencies’ standards, and Federal/State laws.

11. Negotiates contract language with vendors when establishing outside contracts to meet QA office needs, e.g., Credentials Verification Organization contract.

12. Facilitates formalized case reviews as requested by administration; prepares report of findings with recommendations to administration.

MINIMUM QUALIFICATIONS

Education:

Possession of a Master’s Degree from an accredited college or university with a major in a health related field

AND

Experience:

The equivalent of three years of full-time experience in a Behavioral Health Managed Care setting of which a minimum of the equivalent of one year has been in an administrative or supervisory capacity.

License:

Possession of a valid California Driver’s License.

NOTE: The Civil Service Commission may modify the above Minimum Qualifications in the announcement of an examination.

KNOWLEDGE AND SKILLS

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:

• Principles and practices of clinical systems, quality assurance, quality management, quality improvement and risk management principles in a managed behavioral health care setting.
• Organization and functioning of a managed behavioral health care setting.
• Current applicable federal, state, county laws, codes, and regulations and their reporting requirements.
• Knowledge of patient (client) care issues.
• Current trends, research, and issues in treatment and prevention as they relate to QA/QM/QI in a managed behavioral health care system.
• CQI tools and principles in regards to the measurement and assessment of data collection with subsequent analysis of outcomes.
• General administrative practices and principles; personnel management/supervision.
• Community standards of quality clinical practice, diagnosis, assessment, treatment planning and documentation.


Ability to:

• Planning and organizing.
• Decision-making and judgment.
• Analyzing and problem solving.
• Maintenance of accurate records.
• Development and implementation of QA/QM/QI principles.
• Leadership skills.
• Written and verbal communication.
• Interpersonal sensitivity.
• Manage multiple tasks and responsibilities.

CLASS SPEC HISTORY

AM:co
Newspecs: 5080.doc
5/22/00
CSC Date: 7/5/00
SP:cs Revised 7/21/15
CSC Date: 8/5/15

BENEFITS

Alameda 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 different employee discount, fitness and health screening programs focused on overall well being.  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, 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
• 1^st United Services Credit Union 

*Eligibility is determined by Alameda County and offerings may vary by collective bargaining agreement.  This provides a brief summary of the benefits offered and can be subject to change.

** Non-exempt management employees are entitled to up to three days of management paid leave. Exempt management employees are entitled to up to seven days of management paid leave.