Denton County MHMR Center, a Certified Community Behavioral Health Clinic (CCBHC), is committed to fostering a supportive, trauma-informed, and welcoming environment for all. We strive to create a collaborative and encouraging atmosphere where individuals feel respected, valued, and empowered. Integrity, honesty, and kindness are the foundation of our Center, ensuring the delivery of high-quality, trauma informed, person-centered care.

General Description

Under direction of the Program Manager of Quality Management and within federal, state and local guidelines performs routine quality assurance work. Work involves planning, developing, and administering internal quality assurance and compliance activities.

The Quality Assurance MH Specialist/Rights Protection Officer is responsible for monitoring and conducting activities under the supervision of the Director of Quality Management, Rights Protection & Authority Administrative Services. The position is responsible for the implementation of an on-going quality assurance program designed to objectively and systematically monitor and evaluate the quality and appropriateness of mental health services, pursue opportunities to improve consumer care and resolve problems. This position will be directly responsible for carrying out quality improvement processes and strategies focusing on mental health services and producing reports associated with quality assurance monitoring. This will include but is not limited to record audit reviews, utilization reviews, outcome evaluations, scheduled self-assessment data verification reviews, death reviews, safety and consumer satisfaction surveys. Works under moderate supervision, with limited latitude for the use of initiative and independent judgment.

Education, Training, and Experience

· Graduation from an accredited four-year college or university with major course work in psychology, sociology, special education, rehabilitation counseling, or a related human services field and a minimum of twelve (12) months experience working with persons with mental health or intellectual and developmental disabilities.

OR

· Associate degree and a minimum of twenty-four months experience required.

OR

· No degree and a minimum of forty-eight months’ experience required.

Registration, Certification, Licensure, and Other Qualifications

· Must have and maintain a background and criminal history free from any disqualifying offenses as outlined by the Texas Administrative Code (TAC) and the Health and Human Services Commission (HHSC).

· Must possess and maintain a valid driver’s license and automobile insurance.

o Individuals with an out-of-state driver’s license must be able to obtain a driver’s license in the state of Texas within thirty (30) days.

· Successful completion of all position-specific training within thirty (30) days of employment is required.

Knowledge, Skills, and Abilities

· Knowledge of federal and state programs, policies and laws of financial and medical eligibility program policies, and of quality control procedures.

· Skills in interviewing, in analyzing data, and in using computer programs and software.

· Ability to apply program and quality control policies and procedures; to ensure compliance with state and federal regulations; to select, analyze and evaluate information from case records in relation to eligibility criteria, and to communicate effectively.

Essential Duties

The following list outlines key responsibilities for the position; however, it is not exhaustive and does not encompass all responsibilities. Additional duties may be assigned as needed.

1. Rights Protection Officer

· Coordinates the MH services related abuse, neglect, rights, and program complaints & investigations process.

· Provides back up to the RPO for IDD services as needed.

· Serves as back up liaison to the Texas Department of Family and Protective Services (DFPS) as needed.

· Coordinates the Center’s appeals and Medicaid Fair Hearings process.

· Conducts all investigative processes according to center policy, procedure and related rules.

· Completes and processes all related documentation within two business days of receipt.

· Ensures current postings of all applicable related information at each Center. Operated/contracted facility and residential programs as required.

· Attends and advocates as appropriate and requested on behalf of a person served within established rules and regulations.

· Provides abuse, neglect, rights and confidentiality (ANRC) training as needed.

· Provides back up to Human Rights Committee (HRC) activities as needed.

2. Consumer satisfaction activities

· Coordinates internal mental health satisfaction surveys in accordance with DSHS rules and regulations, HHSC performance contract and the center’s current policies and procedures.

· Compiles all results in a historical worksheet to track trends and make reports available to supervisor on an annual basis and as needed.

· Conducts follow-up surveys with consumers to ascertain outcome achievement and satisfaction as part of the quality review process as required.

3. Quality review activities

· Develops quality indicators for review of each mental health program service area.

· Conducts reviews on an ongoing basis to assure assessment of current, applicable quality indicators.

· Reviews MH incident, medication error and safety reports.

· Facilitates MH data collection and trending reports.

· Completes mental health medical record reviews as required for center self-assessment activities.

· Compiles deficiency reports and forward to service provider about non-compliant findings.

· Enters results into a historical worksheet to track trends, making reports available as needed.

· Performs trend analysis on ongoing quality review findings and submit trend reports to supervisor as required.

· Completes assigned quality of care investigations.

· Completes assigned focused reviews.

· Coordinates the Centers Death Review process.

4. Quality management committee participation

· Attends utilization management committee meetings.

· Attends Community Resource Coordination Group meetings for

i. Children and Adolescents

ii. Adults

· Attends other committees as assigned or requested to represent quality management interests.

5. Policy and procedure activities

· Assists in drafting, implementing, and evaluation of center wide policies and procedures related to quality management, utilization management, and safety.

· Assists in assuring adherence to center wide policy and procedure as required by standards, regulations, and laws.

6. Safety: Provider relation activities

· Develops and maintain a positive relationship with current providers while carrying out assigned activities.

· Provides technical assistance in the areas of quality management as requested by supervisor and as deemed appropriate based upon relevant review information.

· Exhibits positive representation of the center throughout all correspondence and communication both within and outside the center.

7. Training

· Provides training to staff as required or requested.

· Attends all required training and expand professional knowledge through resource materials, periodicals, etc.

· Successful completion of all staff development training as required for position

8. Attendance

· Reports to and from work site as scheduled.

· Notifies supervisor or designee as soon as possible of any absences, tardiness and submit any required documentation as required.

9. Miscellaneous

· Reports suspected abuse, neglect, or exploitation.

· Submits all requested reports within required and established timeframes.

· Performs additional duties as deemed necessary by department supervisor within designated timeframes.

· Complies with all policies and procedures related to corporate compliance involving Medicaid, Medicare and other payer sources.

· Maintains acceptable driving record as required for DCMHMR insurance