Texas Health and Human Services · 1 day ago
Quality Management Specialist
Houston, TX
Full-time
Hybrid
Mid, Senior Level
$4,523/mo - $7,253/mo
2+ years expTexas Health and Human Services is committed to creating a positive impact in the lives of fellow Texans. The Quality Management Specialist will oversee and manage the Medicaid State Plan Amendment and provide consultative services to ensure compliance with program requirements and improve program effectiveness.
HealthcareHealth Care
No H1B
Responsibilities
Provides complex consultative services and technical assistance to plan, implement, and monitor program services. Works closely with community-based providers and local mental health authorities. (15%)
Develops policies and procedures related to implementation and monitoring of r program services. Ensures that local mental health authorities and other community-based providers receive training on new policies and procedures, and that periodic monitoring takes place. (15%)
Conducts and coordinates desk and onsite reviews to determine compliance with program requirements, laws, regulations, policies, and procedures. Analyzes reviews of program services and develops corrective action plans to improve effectiveness, if needed. Communicates those findings, orally and in writing, to a wide variety of audiences, including HHSC and CMS. (15%)
Ensures that there is continuous quality monitoring program in place to ensure that identified problems are acted upon and resolved promptly. Determines when course corrections are required when program or program provider is not achieving goals or objectives. (15%)
Collects, organizes, analyzes, and prepares material in response to requests for information from internal and external stakeholders. Synthesizes complex information for presentation to a wide variety of groups, orally and in writing. These groups consist of HHSC leadership, CMS and local stakeholders. (15%)
Determines trends and resolves operational problems, within HHSC and within LMHAs and/or provider organizations. These consist of service delivery issues, data collection/submission issues, data entry issues, data analysis issues, invoicing processing issues (by providers), invoice processing issues (by HHSC). (10%)
Participates in State Plan Amendment renewal and amendment and reporting processes. (10%)
Ability to collaborate effectively with behavioral health team and providers. Performs related work as assigned (5%)
Qualification
Required
Graduation from an accredited four-year college or university with major coursework in health services, business administration, human services, social work or a related field is required
At least 2 years experience working within Medicaid or similar program(s)
Licensure Requirements: Licensed Practitioner of the Healing Arts (LPHA) in accordance with Texas Administrative Code 412.303 MENTAL HEALTH COMMUNITY SERVICES
Ability to function effectively in a fast paced environment, to oversee/manage multiple complex projects simultaneously, and to meet deadlines
Ability to exercise initiative and independent judgment
Ability to analyze data for completeness and accuracy and to utilize data to identify issues, trends, and other programmatic needs
Ability to interact with multiple, diverse stakeholder groups
Ability to effectively communicate orally and in writing
Preferred
Experience in quality management is preferred
Knowledge of quality assurance and monitoring processes, best practice and continuous quality improvement
Familiarity with quality management activities and strategies
Experience operating and overseeing youth programs or mental health programs
Knowledge of federal reporting guidelines
Knowledge of waivers and/or state plan amendments
Knowledge of program planning and implementation
Knowledge of public mental health systems
Knowledge of mental health issues and treatment modalities
Knowledge of Medicaid services
Benefits
100% paid employee health insurance for full-time eligible employees
Defined benefit pension plan
Generous time off benefits
Numerous opportunities for career advancement
Company
Texas Health and Human Services
Texas Health and Human Services is an agency that focuses on improving health, safety and well-being.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Dr. Napoleon Broughton
Chief Executive Officer: Life Enhancement Solutions
John F. Palermo
CTO Strategic Analyst VI
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