Quality Assurance Reviewer

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

Best People, Best Solutions, Best Results

The Quality Assurance Reviewer determines the degree to which individuals with intellectual or developmental disabilities (I/DD) are receiving person-centered supports and services according to their needs and goals. Determines the degree to which developmental disability service providers ensure individuals health and safety for individuals receiving services and conform to program standards while meeting state requirements.

Essential Duties and Responsibilities:

• Conducts detailed evaluations of provider performance and the presence of person-centered supports using applicable tools and guidelines.
• Initiates contact with service providers to establish interview and review schedules and discuss associated protocols, expectations, and responsibilities.
• Conducts interviews with individuals with I/DD, family members, providers of services and/or direct service staff.
• Observes the service environment, follows professional protocols to gather pertinent information and makes decisions for the evaluation process.
• Reviews required documentation to evaluate supports and services and gather pertinent information regarding the quality of the person-centered service delivery system.
• Administers and makes determinations based upon the information gathered from the Person Centered Review (PCR), Provider Discovery Review (PDR) and other applicable tools in a manner that meets established proficiency standards.
• Serves as an expert in identifying both problems and solutions to ensure quality assurance activities appropriately address the needs of individuals with I/DDs. Recognizes each personal situation may be different and uses analytical skills to customize the approach as needed.
• Establishes and maintains a positive and respectful approach with individuals/family members/providers/support coordinators throughout the review process.
• Uses professional judgment and discretion to determine when a report of abuse, neglect and/or exploitation is warranted or a referral to state staff is necessary to maintain the health and safety of individuals receiving services through the Medicaid Waiver program.
• Takes immediate action in the case of abuse, neglect and/or exploitation by reporting directly to the Abuse Registry following established protocols of a mandated reporter.
• Inputs data into a web-based application, summarizes findings, generates discoveries for quality improvement and completes a written report for submission to the provider/support coordinator/or other entity in accordance with pre-established timeframes.
• Works closely with the State Agencies to provide information to facilitate follow-up and technical assistance.
• Provides the State Agencies with information at quarterly meetings concerning provider performance, data trends, and opportunities for quality improvement initiatives.
• Participates actively and effectively in associate development activities such as conference calls, professional meetings, and annual training activities.

To perform the job successfully, an individual should demonstrate the following competencies:

• Analytical - Gathers and analyzes information skillfully; Develops alternative solutions.
• Judgment - Able to make sound decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process when needed; Makes timely decisions.
• Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Able to see roadblocks as challenges; Works well in group problem solving situations.
• Customer Service - Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness, Engages in self development, keeps up with new developments.
• Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; Demonstrates support of organization's goals and values; Benefits organization through outside activities.
• Planning/Organizing - Able to prioritize, organize, and plan work activities; Uses time efficiently; Sets goals and objectives; Develops realistic action plans; Demonstrates flexibility and the ability to adapt to changes.

Education and/or Experience

• Minimum of Bachelor's degree in a human services related field
• At least five years of direct experience working in the field of intellectual and developmental disabilities, which also meets the criteria of a Qualified Intellectual Disabilities Professional (QIDP).
• Exceptions to the type of bachelor's degree earned must be approved by the AHCA contract manager.

Qlarant, Inc is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.